High drug-pathogen mismatch in the management of invasive carbapenem-resistant Enterobacteriaceae infections at a tertiary hospital in Nigeria

• Published in: IJID regions Vol. 12; p. 100407
• Main Authors: Adekanmbi, Olukemi, Popoola, Oluwafemi, Fowotade, Adeola, Idowu, Olusola, Ogunbosi, Babatunde, Lakoh, Sulaiman, Adebiyi, Ini
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-09-2024
• Subjects: Antimicrobial resistance; Antimicrobial stewardship; Bacteria; Carbapenem-resistant Enterobacteriaceae; Infection prevention and control; Carbapenem-resistant Enterobacteriaceae; Bacteria; Antimicrobial stewardship; Antimicrobial resistance; Infection prevention and control
• ISSN: 2772-7076; 2772-7076
• DOI: 10.1016/j.ijregi.2024.100407

•Carbapenem-resistant Enterobacteriaceae (CRE) are routinely cultured from clinical specimens in Nigerian hospitals.•Empiric antibiotics are often inappropriate for the treatment of CRE.•Inappropriate treatment for CRE is continued or initiated despite culture data.
This study aims to provide lacking data on antibiotics and treatment strategies used in the management of carbapenem-resistant Enterobacteriaceae (CRE) infections in Nigeria.
A cross-sectional study was carried out at the University College Hospital in Ibadan. CRE isolated from routine culture of specimens from hospitalized patients from December 2021 to September 2022 was identified. Treatment information and other data were collected from the patients’ medical records.
The hospital laboratory isolated CRE from 55 patients during the study period and 27 (49.1%) of them had data available for the study. The most frequently isolated CRE was Klebsiella spp. (13 of 27, 48.1%). Of the 24 patients who received empiric antibiotics, only two (8.3%) of their CRE isolates were susceptible. After receiving culture results, 18 (66.7%) patients were treated with at least one antibiotic, to which resistance was documented. Only three (11.1%) patients overall commenced or remained on an antibiotic, to which their CRE isolate was susceptible.
Despite culture data, we found a high prevalence of drug-pathogen mismatch in CRE treatment, including new or persistent use of antibiotics, to which resistance was documented. Antimicrobial stewardship efforts need to be strengthened to specifically address CRE treatment and effective antibiotics need to be made accessible.