Management of Carbapenem-Resistant Enterobacteriaceae Bloodstream Infections: An Experience from a Tertiary Care Centre in Oman

The emergence of Carbapenem-resistant Enterobacteriaceae (CRE)is a public health concern worldwide. It is associated with increased mortality due to limited antibiotics available to treat CRE infections. The aim of this study was to understand the epidemiology of CRE infections, associated mortality, and available treatment options. All patients with CRE isolated in blood culture were identified between December 2011 and October 2019. Risk factors and mortality associated with each risk factor at 14 and 30 days were determined.55 cases of CRE bloodstream infections were isolated, with a median age of 56 years. Eighty-four percent of patients received treatment in the ICU. All cases were caused by Klebsiella pneumonia. The rate of resistance to the tested antibiotics was as follows: meropenem 92% (50/54), imipenem 75% (40/53), etrapenam 95% (19/20), Amikacin 71% (37/52), cotrimoxazole 73% (40/53), Gentamicin 47% (25/53) and colistin 7% (3/41). Major risk factors associated were the presence of a urinary catheter (84%), central venous catheter (78%), mechanical ventilation (74%) and post-surgery (67%). Mortality at 14 days and 30 days was 41%, and 52%, respectively. Univariate analysis showed that 14 days mortality was higher in patients with central venous catheter (P=0.01). Charlson's comorbidity index was associated with an increased risk of death at 30 days (P=0.04). There was no statistically increased survival in those treated with combination therapy at 30 days (P=0.5). The mortality of CRE infections seems to be high and optimal therapy is not yet well defined. Combination therapy is not associated with increased survival in this cohort of patients.