Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses at National Institute for Communicable Diseases, Division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.
Department of Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
Eur J Clin Microbiol Infect Dis. 2020 Jul;39(7):1287-1294. doi: 10.1007/s10096-020-03845-4. Epub 2020 Mar 2.
Enhanced surveillance for CREs was established at national sentinel sites in South Africa. We aimed to apply an epidemiological and microbiological approach to characterise CREs and to assess trends in antimicrobial resistance from patients admitted to tertiary academic hospitals. A retrospective analysis was conducted on patients of all ages with CRE bacteraemia admitted at any one of 12 tertiary academic hospitals in four provinces (Gauteng, KwaZulu-Natal, Western Cape and Free State) in South Africa. The study period was from July 2015 to December 2018. A case of CRE bacteraemia was defined as a patient admitted to one of the selected tertiary hospitals where any of the Enterobacteriaceae was isolated from a blood culture, and was resistant to the carbapenems (ertapenem, meropenem, imipenem and/or doripenem) or had a positive result for the Modified Hodge Test (MHT) according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. A positive blood culture result obtained after 21 days of the last blood culture result was regarded as a new case. To distinguish hospital-acquired (HA) from the community-acquired (CA) bacteraemia, the following definitions were applied: the HA CRE bacteraemia was defined as a patient with CRE isolated from blood culture ≥ 72 h of hospital admission or with any prior healthcare contact, within 1 year prior to the current episode or referral from a healthcare facility where the patient was admitted before the current hospital. A case of the CA CRE bacteraemia was defined as a patient with CRE isolated from blood culture < 72 h of hospital admission and with no prior healthcare contact. The majority of carbapenem-resistant Enterobacteriaceae (CRE) (70%) were hospital-acquired (HA) with Klebsiella pneumoniae being the predominant species (78%). In-hospital mortality rate was 38%. The commonest carbapenemase genes were bla- (52%) and bla- (34%). The high mortality rate related to bacteraemia with CRE and the fact that most were hospital-acquired infections highlights the need to control the spread of these drug-resistant bacteria. Replacement with OXA-48 is the striking finding from this surveillance analysis. Infection control and antibiotic stewardship play important roles in decreasing the spread of resistance.
南非在国家哨点建立了对 CRE 的强化监测。我们旨在应用流行病学和微生物学方法来描述 CRE，并评估从三级学术医院入院患者的抗生素耐药趋势。对 2015 年 7 月至 2018 年 12 月期间在南非四个省（豪登省、夸祖鲁-纳塔尔省、西开普省和自由邦省）的 12 家三级学术医院入院的所有年龄段 CRE 菌血症患者进行了回顾性分析。CRE 菌血症的定义为在选定的三级医院之一入院的患者，从其血液培养物中分离出任何肠杆菌科细菌，且对碳青霉烯类（厄他培南、美罗培南、亚胺培南和/或多利培南）耐药，或根据临床和实验室标准协会 (CLSI) 指南对改良 Hodge 试验 (MHT) 呈阳性。将最后一次血培养后 21 天获得的阳性血培养结果视为新病例。为了区分医院获得性 (HA) 和社区获得性 (CA) 菌血症，应用了以下定义：HA CRE 菌血症定义为从血液培养物中分离出 CRE 的患者，其在入院后≥72 小时或在当前发病前 1 年内有任何先前的医疗接触，或在患者当前入院前被收治的医疗机构有任何先前的医疗接触。CA CRE 菌血症的定义为从血液培养物中分离出 CRE 的患者，其在入院后 <72 小时，且无先前的医疗接触。大多数耐碳青霉烯肠杆菌科细菌 (CRE)（70%）为医院获得性（HA），其中肺炎克雷伯菌为主要物种（78%）。院内死亡率为 38%。最常见的碳青霉烯酶基因是 bla- (52%) 和 bla- (34%)。与 CRE 菌血症相关的高死亡率以及大多数为医院获得性感染这一事实突出表明需要控制这些耐药菌的传播。从本次监测分析中发现的一个显著结果是 OXA-48 的替代。感染控制和抗生素管理在减少耐药传播方面发挥着重要作用。
