Epidemiology and resistance profiles of Enterobacterales in a tertiary care hospital in Lebanon: a 4-year retrospective study

Abstract

Introduction: Antimicrobial resistance (AMR) is a worldwide problem that threatens treatment effectiveness against the most serious bacterial infections. AMR in Enterobacterales is highly prevalent in Lebanon. However, recent reports regarding the distribution of Enterobacterales and related antimicrobial susceptibility are scarce.

Methodology: In this retrospective study at the Lebanese Hospital Geitaoui Medical Center in Lebanon, all data regarding culture specimens from urine, blood, sputum, deep tracheal aspirate, broncho-alveolar lavage, wounds, surgical sites, tissue, body fluids, and central venous catheter that were positive for at least one of the 4 bacterial isolates (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae and Proteus mirabilis) were collected. All susceptibility testing was performed according to the Clinical and Laboratory Standards Institute guidelines.

Results: A total of 4283 non-duplicate Enterobacterales were isolated during the study period (January 2017 to December 2020). Urine was the most common site of infection. E. coli was the most detected isolate as well as the leading pathogen in urine, wounds and surgical sites, and blood. Regarding antimicrobial susceptibility, the mean susceptibility to third generation cephalosporins was 55.53% and a mean extended-spectrum β-lactamases production of 31.2% was measured in E. coli. Mean carbapenem susceptibility was the lowest in K. pneumoniae and E. cloacae. The lowest mean susceptibility to fluoroquinolones was detected in E. coli isolates.

Conclusions: This study identified the predominance of E. coli among Enterobacterales in Lebanese patients, with the urinary tract being the most common site of infection and underlined the high rates of AMR in Enterobacterales in Lebanon.