Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center
Introduction: Carbapenem resistant organisms (CRO) constitute a large group of bacteria with different mechanisms of resistance and recently increasing global incidence. This rise has ambiguous dynamics and essential local epidemiologic data is lacking. Materials and methods: In this retrospective s...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Journal of Infection and Public Health |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034119300905 |
| _version_ | 1818605714729336832 |
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| author | Amanda Chamieh Gerard El-Hajj Omar Zmerli Claude Afif Eid Azar |
| author_facet | Amanda Chamieh Gerard El-Hajj Omar Zmerli Claude Afif Eid Azar |
| author_sort | Amanda Chamieh |
| collection | DOAJ |
| description | Introduction: Carbapenem resistant organisms (CRO) constitute a large group of bacteria with different mechanisms of resistance and recently increasing global incidence. This rise has ambiguous dynamics and essential local epidemiologic data is lacking. Materials and methods: In this retrospective study at the 400-bed Saint George Hospital (SGH) in Beirut, Lebanon, we retrieved electronic laboratory records of all intrinsic and acquired CRO isolates from January 1, 2010 until June 30, 2018. Isolation density was calculated as: number of isolates/1000PD. Analysis carried out using WHOnet with a trend time series analysis. Results: During the study period, a total of 2150 non-duplicate CRO were isolated. While Acinetobacter baumanii (AB), Pseudomonas aeruginosa (CRPa), and Stenotrophomonas maltophilia (Sm) constituted 85% of total CRO in the study period, the carbapenem resistant enterobacteriaceae (CRE) rose from few sporadic cases before 2016 to a solid 32% of total CRO in 2018. Our most concrete trends were as follows. The rate of AB bacteremia was at an average of 0.114/1000 PD from 2011 to 2014. In 2015, a sudden doubling of AB bacteremia to 0.23/1000 PD. In 2017, there was a significant decrease to 0.113/1,000PD (p < 0.0001) to reach 0.097/1000PD in 2018 with a continuously declining trend. The peak of Sm bacteremia was in 2016 at 0.121/1000PD after which it significantly decreased by 21% in 2017 to disappear in 2018 (p < 0.0001). There were no significant trends observed in the isolation density of the CRPa group from 2010 until June 2018. Klebsiella pneumonia (CRKp) bacteremia was isolated first in 2013, then in 2016 and continued to rise (p = 0.028). In 2017, carbapenem resistant KP bacteremia rate doubled to 0.05/1,000PD from 0.024/1000 (p = 0.0139). Conclusion: In conclusion, this 9-year study at SGH depicts the major trends and dynamics of local CRO isolation, mainly A. baumanii, P. aeruginosa and CRKp. Further efforts are warranted both locally and internationally for a richer understanding of this trend. Bearing in mind that understanding antimicrobial resistance is a complex, multifaceted process that is only feasible when all its aspects are combined: molecular, phenotypic and clinical. |
| first_indexed | 2024-12-16T13:59:21Z |
| format | Article |
| id | doaj.art-143a389cb74e429aa5470f7014e5d437 |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-12-16T13:59:21Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
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| series | Journal of Infection and Public Health |
| spelling | doaj.art-143a389cb74e429aa5470f7014e5d4372022-12-21T22:29:08ZengElsevierJournal of Infection and Public Health1876-03412020-12-01131221012106Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical CenterAmanda Chamieh0Gerard El-Hajj1Omar Zmerli2Claude Afif3Eid Azar4Saint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, P.O. Box 166 378, Achrafieh, Beirut 11 00 2807, LebanonSaint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, P.O. Box 166 378, Achrafieh, Beirut 11 00 2807, LebanonSaint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, P.O. Box 166 378, Achrafieh, Beirut 11 00 2807, LebanonSaint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, P.O. Box 166 378, Achrafieh, Beirut 11 00 2807, LebanonCorresponding author.; Saint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, P.O. Box 166 378, Achrafieh, Beirut 11 00 2807, LebanonIntroduction: Carbapenem resistant organisms (CRO) constitute a large group of bacteria with different mechanisms of resistance and recently increasing global incidence. This rise has ambiguous dynamics and essential local epidemiologic data is lacking. Materials and methods: In this retrospective study at the 400-bed Saint George Hospital (SGH) in Beirut, Lebanon, we retrieved electronic laboratory records of all intrinsic and acquired CRO isolates from January 1, 2010 until June 30, 2018. Isolation density was calculated as: number of isolates/1000PD. Analysis carried out using WHOnet with a trend time series analysis. Results: During the study period, a total of 2150 non-duplicate CRO were isolated. While Acinetobacter baumanii (AB), Pseudomonas aeruginosa (CRPa), and Stenotrophomonas maltophilia (Sm) constituted 85% of total CRO in the study period, the carbapenem resistant enterobacteriaceae (CRE) rose from few sporadic cases before 2016 to a solid 32% of total CRO in 2018. Our most concrete trends were as follows. The rate of AB bacteremia was at an average of 0.114/1000 PD from 2011 to 2014. In 2015, a sudden doubling of AB bacteremia to 0.23/1000 PD. In 2017, there was a significant decrease to 0.113/1,000PD (p < 0.0001) to reach 0.097/1000PD in 2018 with a continuously declining trend. The peak of Sm bacteremia was in 2016 at 0.121/1000PD after which it significantly decreased by 21% in 2017 to disappear in 2018 (p < 0.0001). There were no significant trends observed in the isolation density of the CRPa group from 2010 until June 2018. Klebsiella pneumonia (CRKp) bacteremia was isolated first in 2013, then in 2016 and continued to rise (p = 0.028). In 2017, carbapenem resistant KP bacteremia rate doubled to 0.05/1,000PD from 0.024/1000 (p = 0.0139). Conclusion: In conclusion, this 9-year study at SGH depicts the major trends and dynamics of local CRO isolation, mainly A. baumanii, P. aeruginosa and CRKp. Further efforts are warranted both locally and internationally for a richer understanding of this trend. Bearing in mind that understanding antimicrobial resistance is a complex, multifaceted process that is only feasible when all its aspects are combined: molecular, phenotypic and clinical.http://www.sciencedirect.com/science/article/pii/S1876034119300905Carbapenem resistant enterobacteriaceaeCarbapenem resistant organismsCRE epidemiology |
| spellingShingle | Amanda Chamieh Gerard El-Hajj Omar Zmerli Claude Afif Eid Azar Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center Journal of Infection and Public Health Carbapenem resistant enterobacteriaceae Carbapenem resistant organisms CRE epidemiology |
| title | Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center |
| title_full | Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center |
| title_fullStr | Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center |
| title_full_unstemmed | Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center |
| title_short | Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center |
| title_sort | carbapenem resistant organisms a 9 year surveillance and trends at saint george university medical center |
| topic | Carbapenem resistant enterobacteriaceae Carbapenem resistant organisms CRE epidemiology |
| url | http://www.sciencedirect.com/science/article/pii/S1876034119300905 |
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