Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.
PLoS One. 2024 Aug 26;19(8):e0309315. doi: 10.1371/journal.pone.0309315. eCollection 2024.
Carbapenem resistant Enterobacterales (CRE) have become established as leading pathogens in South African healthcare facilities. The aim of this study is to describe the epidemiology of CRE carriage and clinical infection episodes at healthcare facilities in the Western Cape Province of South Africa (2016-2020), and identify factors associated with mortality in CRE infected patients.
We used routine data from the Provincial Health Data Centre to track the emergence of CRE in healthcare facilities in the Western Cape Province of South Africa. We included all CRE episodes (clinical and carriage) at Western Cape hospitals (including day and inpatients) from 2016 to 2020 to determine the distribution of CRE, patient demographics and antibiotic resistance phenotypes. Logistic regression was performed to identify factors associated with mortality from clinical CRE episodes.
2242 CRE episodes (1580 [70.5%] clinical and 662 [29.5%] carriage) were identified. From these, 2281 CRE isolates were identified, with Klebsiella species predominating (1644, 72.1%). Affected patients had a median age of 31 (IQR 0-52) years, and 1167 (52.0%) were male. Most CRE episodes were recorded in central hospitals (70.0%, p < 0.001). Where outcome data was available, crude in-hospital mortality rates were 26.9% (371/1379) for CRE clinical episodes versus 6.4% (41/640) for CRE carriage episodes (p < 0.001). Factors that showed a statistically significant association with in-hospital mortality were female sex [adjusted odd ratio (aOR) 1.40 (95% confidence interval (CI) 1.09-1.560)], adult patients [aOR 1.76 (95% CI 1.20-2.57)], CRE isolation from a sterile specimen [aOR 0.41 (95% CI 0.32-0.53)], and >3 days between hospital admission and specimen collection [aOR 1.56 (95% CI 1.11-2.18)].
CRE episodes at Western Cape healthcare facilities are concentrated at tertiary hospitals, with high case fatality rates in patients with clinical CRE episodes. Infection control interventions must be strengthened to reduce transmission of CRE, and to reduce infection risks.
耐碳青霉烯肠杆菌科（CRE）已成为南非医疗机构中主要的病原体。本研究旨在描述南非西开普省（2016-2020 年）医疗机构中 CRE 定植和临床感染病例的流行病学，并确定与 CRE 感染患者死亡相关的因素。
我们使用省级卫生数据中心的常规数据来跟踪南非西开普省医疗机构中 CRE 的出现。我们纳入了 2016 年至 2020 年西开普省医院（包括日间和住院患者）的所有 CRE 病例（临床和定植），以确定 CRE 的分布、患者人口统计学和抗生素耐药表型。使用逻辑回归确定与临床 CRE 病例死亡率相关的因素。
共发现 2242 例 CRE 病例（1580 例[70.5%]为临床病例，662 例[29.5%]为定植病例）。在这些病例中，共分离出 2281 株 CRE 分离株，以克雷伯菌属为主（1644 株，占 72.1%）。受影响的患者中位年龄为 31 岁（IQR 0-52 岁），1167 例（52.0%）为男性。大多数 CRE 病例发生在中心医院（70.0%，p < 0.001）。在有结局数据的病例中，CRE 临床病例的院内死亡率为 26.9%（371/1379），而 CRE 定植病例的院内死亡率为 6.4%（41/640）（p < 0.001）。与院内死亡率有统计学显著关联的因素包括女性（调整后的优势比[aOR]1.40（95%置信区间[CI]1.09-1.560）]、成年患者[aOR 1.76（95% CI 1.20-2.57）]、从无菌标本中分离出 CRE[aOR 0.41（95% CI 0.32-0.53）]以及入院与标本采集之间间隔>3 天[aOR 1.56（95% CI 1.11-2.18）]。
西开普省医疗机构的 CRE 病例集中在三级医院，临床 CRE 病例的病死率较高。必须加强感染控制干预措施，以减少 CRE 的传播，并降低感染风险。
