Epidemiology and clinical outcomes of monomicrobial carbapenem-resistant Enterobacteriaceae (CRE) from a metropolitan area of Kerala, India

Abstract

Introduction: The emergence of Carbapenem-resistant Enterobacteriaceae (CRE) is a major public health threat in India posing challenges in infection management. Our study aims to address the regional incidence of monomicrobial CRE in a metropolitan area of Kerala and characterize prescriptions in relation to clinical management.

Methodology: The multicentre, prospective observational study was conducted in secondary and tertiary care centres jointly following public-private partnership model in Ernakulam district of Kerala, India from October 2018 to October 2019.

Results: The overall incidence of monomicrobial CRE-positive cases from the study hospital network was found to be 0.855 per 1000 patient-days. Among the available data in the cohort, 77 % (312/405) were observed to attain clinical cure and in-hospital all-cause mortality was at 20% (83/410). The proportion of patients with clinical cure to treatment was found to be significantly higher than clinical failure among patients with urinary tract infections (p < 0.001, OR 2.88, 95% CI 1.73 – 4.79) and pneumonia (p < 0.001, OR 0.36, 95% CI 0.21 - 0.6) at 87% and 61% respectively in comparison to other infections. The prevalence of colistin resistance among the total number of patients recruited with isolated monomicrobial CRE was found to be at 3%.

Conclusions: Our prospective study on the regional epidemiology of monomicrobial CRE has revealed notable incidence and all-cause mortality. The antimicrobial regimens for clinical management detailed in the study and the assessment of focus of infection-based clinical cure status rates indicate the need of optimized antimicrobial therapy to improve treatment practices in CRE infections.