Macrolides: a novel risk factor for carbapenemase-producing Enterobacterales in intensive care units

  • Carmen Soria-Segarra Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica Santiago de Guayaquil. Guayaquil, Ecuador
  • Claudia Soria-Segarra Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica Santiago de Guayaquil. Guayaquil, Ecuador
  • Angel Catagua-González Sociedad Ecuatoriana de Estadística. Quito, Ecuador
  • Marcia Apolo-Matamoros Universidad de Especialidades Espíritu Santo. Samborondón, Ecuador
  • Franklin Vega-Franco Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica Santiago de Guayaquil. Guayaquil, Ecuador
  • Miguel Chung-Sang Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica Santiago de Guayaquil. Guayaquil, Ecuador
  • César Narváez-Peñaloza Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica Santiago de Guayaquil. Guayaquil, Ecuador
  • Raquel Quijano-Grunauer Hospital Abel Gilbert Pontón. Guayaquil, Ecuador
  • José Gutiérrez-Fernández Department of Microbiology, School of Medicine and PhD Program in Clinical Medicine and Public Health, University of Granada-ibs. Granada, España
Keywords: Carbapenemase, Enterobacterales, risk factors, intensive care unit

Abstract

Introduction: Carbapenemase-producing Enterobacterales (CPE) have emerged as a substantial cause of morbi-mortality worldwide, with a prevalence of approximately 5% in areas with high endemicity. However, available data may not be representative of developing countries, such as Ecuador. In this study, the incidence of CPE in Ecuador and risk factors for infection/colonisation were evaluated.

Methodology: A prospective cohort study was performed from February to April 2016 in seven intensive-care units of Guayaquil, Ecuador. Samples were processed according to the Centers for Disease Control and Prevention laboratory protocol and the CHROMagar mSuper CARBA agar method. Resistance to carbapenems was defined according to Clinical and Laboratory Standards Institute breakpoints. A modified carbapenemase inactivation method was used to identify carbapenamase production phenotypically with molecular confirmation by multiplex polymerase chain reaction.

Results: In total, 640 patients were enrolled. The incidence of CPE was 36.4% (N = 233). A multivariate analysis indicated that several factors were associated with CPE acquisition, included a long intensive care unit stay (OR 1.05; 95% CI 1.03–1.08; p < 0.01), tracheostomy (OR 3.52; 95% CI 1.90–6.75; p < 0.01), hospitalisation 3 months prior to admission (OR 2.07; 95% CI 1.17–3.71; p < 0.01), vancomycin use (OR 3.31; 95% CI 2.02–5.18; p < 0.01), and macrolide use (OR 3.31; 95% CI 1.43–7.76; p < 0.01).

Conclusions: Macrolide use was a risk factor for CPE acquisition. This association should be evaluated further, especially in developing countries.

Published
2021-04-30
How to Cite
1.
Soria-Segarra C, Soria-Segarra C, Catagua-González A, Apolo-Matamoros M, Vega-Franco F, Chung-Sang M, Narváez-Peñaloza C, Quijano-Grunauer R, Gutiérrez-Fernández J (2021) Macrolides: a novel risk factor for carbapenemase-producing Enterobacterales in intensive care units. J Infect Dev Ctries 15:584-589. doi: 10.3855/jidc.13319
Section
Brief Original Articles