Epidemiology, antimicrobial resistance profile and management of carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia.

IF 4.6 2区 医学 Q1 MICROBIOLOGY
Eshetu Gadisa, Beverly Egyir, Bright Adu, Hawawu Ahmed, Guta Disasa, Tesfaye Sisay Tessema
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引用次数: 0

Abstract

Background: Early detection and proper management of maternal sepsis caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) can significantly reduce severe complications and maternal mortality. This study aimed to describe the epidemiology, antimicrobial resistance profile, and management of carbapenem-resistant K. pneumoniae among sepsis-suspected maternal cases in Ethiopia.

Methods: A prospective cross-sectional study was conducted in five tertiary hospitals from June 2021 to December 2023. Isolation, identification, and antimicrobial susceptibility testing of the isolates were carried out following standard microbiological procedures as stated in the CLSI guidelines. Data on socio-demographics, risk factors, and management strategies were collected with structured questionnaires. Associations between variables were determined using logistic regression analysis in STATA-21. A p-value of less than 0.05 was statistically significant.

Results: Of the 5613 total women suspected of having maternal sepsis, 609 (10.8%) of them were infected with K. pneumoniae. The prevalence rates of MDR, XDR, and PDR K. pneumoniae strains were 93.9%, 24.3%, and 10.9%, respectively. The resistance rates for the last-resort antibiotics; amikacin, tigecycline, carbapenem, and third-generation cephalosporin were 16.4%, 29.1%, 31.9%, and 93.0%, respectively. The combination of carbapenem with tigecycline or amikacin therapy was used to manage maternal sepsis caused by cephalosporin-and carbapenem-resistant strains. Sepsis associated risk factors, including septic abortion [AOR = 5.3; 95%CI:2.2-14.4]; extended hospitalization [AOR = 3.7; 95%CI: 1.6-19.4]; dilatation and curettage [AOR = 2.2; 95%CI:1.3-13.4]; cesarean wound infection [AOR = 4.1; 95%CI:2.0-9.2]; indwelling catheterization [AOR = 2.1;95%CI: 1.4-6.2]; ICU admission [AOR = 4.3; 95%CI:2.4-11.2]; post abortion [AOR = 9.8; 95%CI:5.7-16.3], and recurrent UTI [AOR = 3.3; 95%CI: 1.6-13.2] were significantly associated with maternal sepsis caused by K. pneumoniae.

Conclusions: The prevalence of maternal sepsis caused by carbapenem- resistant K. pneumoniae is high and serious attention needs to be given to combat transmission. Therefore, improving awareness, early diagnosis, IPC, integrated maternal surveillance, improved sanitation and efficient antimicrobial stewardship are crucial to combating bacterial maternal sepsis.

埃塞俄比亚疑似败血症母亲中耐碳青霉烯类肺炎克雷伯菌的流行病学、抗菌药耐药性概况和管理。
背景:耐碳青霉烯类肺炎克雷伯氏菌(CRKP)引起的孕产妇败血症的早期发现和适当处理可显著降低严重并发症和孕产妇死亡率。本研究旨在描述埃塞俄比亚败血症疑似病例中耐碳青霉烯类肺炎克雷伯菌的流行病学、抗菌药耐药性概况和处理方法:方法:2021 年 6 月至 2023 年 12 月,在五家三级医院开展了一项前瞻性横断面研究。按照 CLSI 指南规定的标准微生物学程序对分离物进行了分离、鉴定和抗菌药敏感性测试。通过结构化问卷收集了有关社会人口统计学、风险因素和管理策略的数据。使用 STATA-21 中的逻辑回归分析确定变量之间的关联。P值小于0.05为具有统计学意义:结果:在 5613 名疑似患有败血症的产妇中,有 609 人(10.8%)感染了肺炎双球菌。MDR、XDR和PDR肺炎克雷伯菌株的感染率分别为93.9%、24.3%和10.9%。阿米卡星、替加环素、碳青霉烯类和第三代头孢菌素等最后抗生素的耐药率分别为 16.4%、29.1%、31.9% 和 93.0%。碳青霉烯类与替加环素或阿米卡星的联合疗法可用于治疗头孢菌素和碳青霉烯类耐药菌株引起的产妇败血症。脓毒症相关风险因素包括脓毒性流产[AOR = 5.3;95%CI:2.2-14.4];住院时间延长[AOR = 3.7;95%CI: 1.6-19.4];扩张和刮宫[AOR = 2.2;95%CI:1.3-13.4];剖宫产伤口感染[AOR = 4.1;95%CI:2.0-9.2];留置导尿管[AOR = 2.2;95%CI:1.3-13.4];感染[AOR = 2.2;95%CI:1.3-13.4]。2]、留置导尿[AOR = 2.1;95%CI:1.4-6.2]、入住ICU[AOR = 4.3;95%CI:2.4-11.2]、流产后[AOR = 9.8;95%CI:5.7-16.3]和复发性UTI[AOR = 3.3;95%CI:1.6-13.2]与肺炎克雷伯菌引起的产妇败血症显著相关:结论:耐碳青霉烯类抗生素肺炎双球菌引起的孕产妇败血症发病率很高,需要高度重视以防止传播。因此,提高意识、早期诊断、IPC、孕产妇综合监测、改善卫生条件和有效的抗菌药物管理对于抗击细菌性孕产妇败血症至关重要。
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来源期刊
CiteScore
8.60
自引率
0.00%
发文量
49
审稿时长
>12 weeks
期刊介绍: Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases. Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.
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