Evolution of Antimicrobial Resistance Levels of ESKAPE Microorganisms in a Peruvian IV-Level Hospital.

BACKGOUND

The members of the so-called ESKAPE group (, , , , and spp.) are a frequent cause of severe infection, ranking among the most relevant causes of hospital infections. In Peru, few studies, often focused in a single ESKAPE microorganism, have been performed, but none providing an overall and comprehensive long-time analysis of the antibiotic resistance of ESKAPE microorganisms. In the present study, the evolution of antimicrobial resistance levels of ESKAPE microorganisms isolated during 2009 - 2010 (Period 1) and 2012 - 2014 (Period 2) in a IV-level hospital in Lima was analyzed.

MATERIALS AND METHODS

ESKAPE microorganisms were isolated from inpatients clinical samples. Bacterial identification, as well as antimicrobial susceptibility levels for up to 29 antimicrobial agents and presence of Extended-Spectrum β-Lactamases (only established in ) were determined using automatic methods.

RESULTS

Of 9,918 clinical isolates, 1,917/3,777 (50.8%) [JAN/2009-JUN/2010 (Period 1)] and 4764/6141 (46.4%) [JAN/2012-DEC/2014 (Period 2)] belonged to the ESKAPE group ( <0.0001). ESKAPE were more frequent in the intensive care unit (ICU) ( <0.0001). decreased from 5.1% to 4.1% ( <0.5), from 10.5% to 7.0% ( <0.05), and from 12.9% to 11.6% ( <0.05), while, increased from 5.0% to 6.7% ( <0.05), mainly related to an increase in ICU isolates (8.4% 17.1%; <0.05). Overall, high levels of antimicrobial resistance were detected, but with few exceptions ( vancomycin in ), antibiotic resistance levels remained stable or lower in Period 2. Contrarily, showed significantly increased resistance to different cephalosporins, carbapenems and amoxicillin plus sulbactam.

CONCLUSION

The introduction of a successful extensively drug-resistant clone in the ICU is suspected. The isolation of ESKAPE and levels of antibiotic resistance levels have reduced over time.