Emergence and expansion of carbapenem resistant enterobacterales in the Western Cape Province, South Africa

• Published in: PloS one 2024-08, Vol.19 (8), p.e0309315
• Main Authors: Moloto, Kedišaletše, Newton-Foot, Mae, Whitelaw, Andrew, Dramowski, Angela
• Format: Article
• Language: English
• Subjects: Access to information; Adolescent; Adult; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Antimicrobial agents; Bacterial infections; Biology and Life Sciences; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Carbapenems; Carbapenems - pharmacology; Carbapenems - therapeutic use; Care and treatment; Child; Child, Preschool; Data collection; Demographics; Drug resistance; E coli; Enterobacter; Enterobacteriaceae; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enterobacteriaceae Infections - mortality; Epidemiology; Female; Health aspects; Health care; Health care facilities; Health facilities; Health risks; Hospital Mortality; Hospitals; Humans; Infant; Infant, Newborn; Infections; Klebsiella; Laboratories; Male; Medicine and Health Sciences; Middle Aged; Mortality; Pathogens; Patient outcomes; Patients; People and places; Phenotypes; Public health; Research and Analysis Methods; Resistance factors; Sex ratio; South Africa - epidemiology; Statistical analysis; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0309315

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.