Trends of Carbapenem Non-susceptibility among Enterobacteriae in Critical Care and Non-Critical Care Unit in Karachi, Pakistan

Abstract

Background: Sepsis due to carbapenem-resistant Enterobacteriae is associated with high morbidity and mortality. The susceptibility data with trends of antimicrobial resistance is essential for monitoring and ensuring the appropriate empirical treatment. Here, we have investigated the carbapenem non-susceptibility trends in Enterobacteriae isolated in blood from admitted patients over six years and evaluated carbapenem consumption within the same period.
Methods: This retrospective study was conducted at the microbiology section of Aga Khan University Hospital, Karachi, from 2011 to 2016. Antimicrobial susceptibility data for non-duplicate Enterobacteriae isolates from the blood culture of inpatients were collected via the laboratory system. The carbapenems dispensed for inpatient use were collected from pharmacy records. The ethical review board approved the study of Aga Khan University, Karachi. The antimicrobial susceptibility data were compared between isolates from patients admitted in the critical unit (CU) and non-critical unit (NCU).

Results: A total of 1822 non-duplicate Enterobacteriae isolates from NCU (n=1506, 83%) and CU (n=316, 17%) were identified
from laboratory data. E. coli was the most identified pathogen (n=1105, 61%). Over-all, 288 (16 %) isolates were nonsusceptible to carbapenems. The carbapenem non-susceptibility in CU (n=85, 27%) was double that of NCU (n=203, 13.4%). The carbapenem trend revealed a positive linear trend with the r² regression fit model 80% for NCU and CU 89%. The meropenem consumption increased from 40 to 85 within the study period.
Conclusion: This study shows that the trend of carbapenem non-susceptibility has increased over the study period, more so for the critical care unit.
Keywords: Enterobacteriales, Carbapenem non susceptible,Carbapenem resistance, Critical care, Non-critical care unit