Molecular detection of carbapenem resistance genes in rectal swabs from patients in Gulf Cooperation Council hospitals
Manaf AlQahtani, Isabella A. Tickler, Zulfa Al Deesi, Wadha Alfouzan, A. Al Jabri, Reem Al Jindan, Sameera Al Johani, S.A. Alkahtani, Amira Al Kharusi, Eiman Mokaddas, Asad Ghulam Nabi, Nermin Kamal Saeed, Abeer Abd El-Aziz Mohamed Madian, John T. Whitmore, Fred C. Tenover
Abstract
Background Gram-negative organisms harbouring carbapenem resistance genes (CRGs) are spreading globally, including in Gulf Cooperation Council (GCC) countries. However, relatively few data are available about carriage of CRGs in hospitalized patients in this region. Aim To determine prevalence of CRG carriage and risk factors for colonization among patients in GCC hospitals. Methods Rectal swabs were obtained from ∼50 intensive care unit (ICU) patients from each of 11 hospitals in five GCC countries between March and November 2019. The swabs were tested for the presence of bla KPC , bla NDM , bla VIM , bla IMP , and bla OXA-48 CRG using a commercial polymerase chain reaction test. Data on risk factors for colonization were collected and analysed. Findings Of 529 specimens screened, 138 (26.1%) were positive for one or more CRGs. The positivity rates among the hospitals ranged from 8.0% to 67.3%; ∼20% of the positive specimens harboured ≥2 CRGs. The most common CRG detected was bla OXA-48 , which was present in 82 specimens (15.5%). Additional CRGs included bla NDM , bla VIM , bla KPC , and bla IMP either alone or in combination. Overall, 31.1% of patients on antibiotics on admission to the ICU were positive for CRGs compared to 16.5% not on antibiotic therapy ( P < 0.001). CRG detection was also more common among patients aged >65 years ( P = 0.027) and increased with hospital length of stay ( P = 0.025). Conclusion The rate of CRGs detected in hospitalized patients in GCC countries varied considerably. Prior antibiotic exposure, increasing age, and prolonged length of stay were associated with CRG detection.