Carbapenem Resistance Among Gram Negative Bacilli In Lagos; Implications For Antimicrobial Stewardship

Abstract

Background: The emergence of carbapenemresistant Gram-negative bacilli (GNB) represents a serious public health threat which requires implementation of antimicrobial stewardship programs to reverse conditions that favour the emergence of multidrug-resistant GNB within the hospital (increased use of carbapenems), thereby reducing morbidity/mortality and healthcare costs. The prevalence of Carbapenem resistant GNB causing infections at LUTH and their resistance pattern to other classes of antimicrobial agents were determined.
Methods: The bacterial isolates were recovered from various clinical specimens in LUTH between January and October 2015.  Antimicrobial susceptibility testing was done using the Modified Kirby-Bauer disc diffusion and gradient diffusion methods and
interpreted using EUCAST 2014 breakpoints tables, version 4.0 and CLSI 2013 guidelines Carbapenem resistance was defined as resistance to any of imipenem (10µg), meropenem (10 µg) or ertapenem (10 µg).
Result: Four hundred and two Gram- negative bacilli were isolated. Seventy one (17.7%) were carbapenem resistant, comprising 16 (59.3%) of the 27 Acinetobacter baumanii, 26 (17%) of the 153 Pseudomonas aeruginosa, and 29 (17%) of the 222 Enterobacteriaece. All carbapenem resistant isolates were multidrug-resistant except one. Most isolates were susceptible to colistin (88 – 100%), polymixin B
(88.5% for Pseudomonas aeruginosa), and tigecycline (44.1% for Enterobacteriaece). Four hundred and two Gram- negative bacilli were
isolated. Seventy one (17.7%) were carbapenem resistant, comprising 16 (59.3%) of the 27 Acinetobacter baumanii, 26 (17%) of the 153
Pseudomonas aeruginosa, and 29 (17%) of the 222 Enterobacteriaece. All carbapenem resistant isolates were multidrug-resistant except one. Most isolates were susceptible to colistin (88 – 100%), polymixin B (88.5% for Pseudomonas aeruginosa), and tigecycline (44.1% for Enterobacteriaece).
Conclusions: There was a high rate of carbapenem resistance among GNB most of which were multi drug resistant. Antimicrobial  stewardship should be instituted with the restricted use of carbapenems. Spread of these multi drug resistant organisms should be prevented with infection control practices like hand hygiene and contact based precaution.