Active surveillance of carbapenem-resistant Gram-negative healthcare-associated infections in a low-middle-income country city

• Published in: The Brazilian journal of infectious diseases 2021-03, Vol.25 (2), p.101540-101540, Article 101540
• Main Authors: Dias, Viviane Maria de Carvalho Hessel, Silva, Daniela Maria Waszak da, Burger, Marion, Oliveira, Alcides Augusto Souto de, Capelo, Patrícia de Jesus, Specian, Fabio Augusto da Rocha, Figueiredo, Marianna Cavina de, Tuon, Felipe Francisco, Baena, Cristina Pellegrino
• Format: Article
• Language: English
• Subjects: Active surveillance; Brazil; Carbapenem resistance; Cross infection; Gram-negative bacterial infections; Healthcare-associated infections; Hospitals; INFECTIOUS DISEASES; Low-middle-income countries; Nosocomial infections; Original; Risk factors; Statistics; Watchful waiting (Medical care)
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2021.101540

Carbapenem-resistance in healthcare-associated infections (HCAIs) is of great concern, and it is urgent to improve surveillance. We aimed to describe and analyze HCAIs trends on Gram-negative antimicrobial susceptibility in a city from a developing country, following the implementation of an active surveillance program. This is an aggregated study describing data from 24 hospitals with intensive care units, including a trend analysis by Joinpoint regression between January 2012 and December 2017. There were 23,578 pathogens in 39,832 HCAIs, from which 16,225 were Gram-negatives (68.8%). Carbapenem susceptibility was lowest in A. baumannii (15.4–25.9%), K. pneumoniae (51.0–55.9%), and P. aeruginosa (64.9–84.1%) and highest in E. coli (96.5–99.2%). Only K. pneumoniae showed a significant Joinpoint at 95% confidence interval: −10.71% (−18.02; −2.75) from 2012 to 2014, p=0.02, and 6.54% (−2.00; 15.83) from 2015 to 2017, p=0.12, which was most influenced by urinary tract infections: −9.98% (−16.02; −3.48) from 2012 to 2014, p=0.01, and 9.66% (−1.75; 22.39) from 2015 to 2017, p=0.09. Although we found a significant change toward an improvement in carbapenem susceptibility in K. pneumoniae, resistance is high for most pathogens. These data should encourage health institutions to improve their prevention and control strategies.