PDF(Pubmed)
Abstract：
Carbapenem-resistant Enterobacterales (CRE) are spreading in the United Arab Emirates (UAE) where their dissemination is facilitated by international travel, trade, and tourism. The objective of this study is to describe the longitudinal changes of CRE as reported by the national AMR surveillance system of the UAE.
In this study, we retrospectively describe CRE isolated from 317 surveillance sites, including 87 hospitals and 230 centers/clinics from 2010 to 2021. The associated clinical, demographic, and microbiological characteristics are presented by relying on the UAE national AMR surveillance program. Data was analyzed using WHONET microbiology laboratory database software (http://www.whonet.org).
A total of 14,593 carbapenem resistant Enterobacterales were analyzed, of which 48.1% were carbapenem resistant Klebsiella pneumoniae (CRKp), 25.1% carbapenem resistant Escherichia coli (CREc), and 26.8% represented 72 other carbapenem resistant species. Carbapenem resistant strains were mostly associated with adults and isolated from urine samples (36.9% of CRKp and 66.6% of CREc) followed by respiratory samples (26.95% for CRKp) and soft tissue samples (19.5% for CRKp). Over the studied period carbapenem resistance rates remained high, especially in K. pneumoniae, and in 2021 were equivalent to 67.6% for imipenem, 76.2% for meropenem, and 91.6% for ertapenem. Nevertheless, there was a statistically significant decreasing trend for imipenem and meropenem resistance in Klebsiella species (p < 0.01) while the decrease in ertapenem resistance was non-significant. Concerning E. coli, there was a statistically significant decreasing trend for meropenem and imipenem resistance over the 12 years, while ertapenem resistance increased significantly with 83.8% of E. coli exhibiting ertapenem resistance in 2021. Resistance rates to ceftazidime and cefotaxime remained higher than 90% (in 2021) for CRKp and cefotaxime rates increased to 90.5% in 2021 for CREc. Starting 2014, resistance to colistin and tigecycline was observed in carbapenem resistant Enterobacterales. CRE were associated with a higher mortality (RR: 6.3), admission to ICU (RR 3.9), and increased length of stay (LOS; 10 excess inpatient days per CRE case).
This study supports the need to monitor CRE in the UAE and draws attention to the significant increase of ertapenem resistance in E. coli. Future surveillance analysis should include a genetic description of carbapenem resistance to provide new strategies.
In this study, we retrospectively describe CRE isolated from 317 surveillance sites, including 87 hospitals and 230 centers/clinics from 2010 to 2021. The associated clinical, demographic, and microbiological characteristics are presented by relying on the UAE national AMR surveillance program. Data was analyzed using WHONET microbiology laboratory database software (http://www.whonet.org).
A total of 14,593 carbapenem resistant Enterobacterales were analyzed, of which 48.1% were carbapenem resistant Klebsiella pneumoniae (CRKp), 25.1% carbapenem resistant Escherichia coli (CREc), and 26.8% represented 72 other carbapenem resistant species. Carbapenem resistant strains were mostly associated with adults and isolated from urine samples (36.9% of CRKp and 66.6% of CREc) followed by respiratory samples (26.95% for CRKp) and soft tissue samples (19.5% for CRKp). Over the studied period carbapenem resistance rates remained high, especially in K. pneumoniae, and in 2021 were equivalent to 67.6% for imipenem, 76.2% for meropenem, and 91.6% for ertapenem. Nevertheless, there was a statistically significant decreasing trend for imipenem and meropenem resistance in Klebsiella species (p < 0.01) while the decrease in ertapenem resistance was non-significant. Concerning E. coli, there was a statistically significant decreasing trend for meropenem and imipenem resistance over the 12 years, while ertapenem resistance increased significantly with 83.8% of E. coli exhibiting ertapenem resistance in 2021. Resistance rates to ceftazidime and cefotaxime remained higher than 90% (in 2021) for CRKp and cefotaxime rates increased to 90.5% in 2021 for CREc. Starting 2014, resistance to colistin and tigecycline was observed in carbapenem resistant Enterobacterales. CRE were associated with a higher mortality (RR: 6.3), admission to ICU (RR 3.9), and increased length of stay (LOS; 10 excess inpatient days per CRE case).
This study supports the need to monitor CRE in the UAE and draws attention to the significant increase of ertapenem resistance in E. coli. Future surveillance analysis should include a genetic description of carbapenem resistance to provide new strategies.
摘要：
■耐碳青霉烯类肠杆菌（CRE）在阿拉伯联合酋长国（UAE）传播，国际旅行促进了它们的传播，贸易,和旅游业。这项研究的目的是描述阿联酋国家AMR监测系统报告的CRE的纵向变化。
■在这项研究中，我们回顾性地描述了从317个监测点中分离出的CRE，2010年至2021年，包括87家医院和230个中心/诊所。相关的临床，人口统计学,和微生物学特征是通过依靠阿联酋国家AMR监测计划来呈现的。使用WHONET微生物学实验室数据库软件(http://www.whonet.org)。
■共分析了14593个碳青霉烯类耐药肠杆菌，其中48.1%为耐碳青霉烯类肺炎克雷伯菌(CRKp),25.1%碳青霉烯类耐药大肠杆菌(CREC),26.8%代表了72种其他碳青霉烯抗性物种。耐碳青霉烯类菌株主要与成人相关，并从尿液样本中分离（CRKp的36.9％和CREC的66.6％），然后是呼吸道样本（CRKp的26.95％）和软组织样本（CRKp的19.5％）。在研究期间，碳青霉烯类耐药率仍然很高，尤其是肺炎克雷伯菌，2021年，亚胺培南占67.6%，美罗培南76.2%，厄他培南占91.6%。然而，在克雷伯菌属中，亚胺培南和美罗培南的抗性有统计学上的显着下降趋势（p<0.01），而对厄他培南的抗性没有显着下降。关于大肠杆菌，在过去的12年中，美罗培南和亚胺培南的耐药性有统计学上的显着下降趋势，而厄他培南耐药性显著增加，2021年83.8%的大肠杆菌表现出厄他培南耐药性。CRKp对头孢他啶和头孢噻肟的耐药率仍高于90%(2021年)，CREC对头孢噻肟的耐药率在2021年上升至90.5%。从2014年开始，在耐碳青霉烯类肠杆菌中观察到对粘菌素和替加环素的耐药性。CRE与较高的死亡率相关(RR：6.3)，入住ICU（RR3.9），并增加住院时间（LOS；每个CRE病例超过10个住院天数）。
■该研究支持需要监测阿联酋的CRE，并提请注意大肠杆菌中厄他培南耐药性的显着增加。未来的监测分析应包括碳青霉烯耐药性的遗传描述，以提供新的策略。
■在这项研究中，我们回顾性地描述了从317个监测点中分离出的CRE，2010年至2021年，包括87家医院和230个中心/诊所。相关的临床，人口统计学,和微生物学特征是通过依靠阿联酋国家AMR监测计划来呈现的。使用WHONET微生物学实验室数据库软件(http://www.whonet.org)。
■共分析了14593个碳青霉烯类耐药肠杆菌，其中48.1%为耐碳青霉烯类肺炎克雷伯菌(CRKp),25.1%碳青霉烯类耐药大肠杆菌(CREC),26.8%代表了72种其他碳青霉烯抗性物种。耐碳青霉烯类菌株主要与成人相关，并从尿液样本中分离（CRKp的36.9％和CREC的66.6％），然后是呼吸道样本（CRKp的26.95％）和软组织样本（CRKp的19.5％）。在研究期间，碳青霉烯类耐药率仍然很高，尤其是肺炎克雷伯菌，2021年，亚胺培南占67.6%，美罗培南76.2%，厄他培南占91.6%。然而，在克雷伯菌属中，亚胺培南和美罗培南的抗性有统计学上的显着下降趋势（p<0.01），而对厄他培南的抗性没有显着下降。关于大肠杆菌，在过去的12年中，美罗培南和亚胺培南的耐药性有统计学上的显着下降趋势，而厄他培南耐药性显著增加，2021年83.8%的大肠杆菌表现出厄他培南耐药性。CRKp对头孢他啶和头孢噻肟的耐药率仍高于90%(2021年)，CREC对头孢噻肟的耐药率在2021年上升至90.5%。从2014年开始，在耐碳青霉烯类肠杆菌中观察到对粘菌素和替加环素的耐药性。CRE与较高的死亡率相关(RR：6.3)，入住ICU（RR3.9），并增加住院时间（LOS；每个CRE病例超过10个住院天数）。
■该研究支持需要监测阿联酋的CRE，并提请注意大肠杆菌中厄他培南耐药性的显着增加。未来的监测分析应包括碳青霉烯耐药性的遗传描述，以提供新的策略。
