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Epidemiology of Carbapenem-resistant Enterobacteriaceae in Egyptian intensive care units using National Healthcare–associated Infections Surveillance Data, 2011–2017

  • Kotb, Sara1
  • Lyman, Meghan2
  • Ismail, Ghada3
  • Abd El Fattah, Mohammad4
  • Girgis, Samia A.5
  • Etman, Ahmed4
  • Hafez, Soad6
  • El-Kholy, Jehan7
  • Zaki, Maysaa El Sayed8
  • Rashed, Hebat-allah G.9
  • Khalil, Ghada M.10
  • Sayyouh, Omar1
  • Talaat, Maha1
  • 1 US Centers for Disease Control and Prevention, Cairo, Egypt , Cairo (Egypt)
  • 2 Centers for Disease Control and Prevention, Atlanta, GA, USA , Atlanta (United States)
  • 3 Supreme Council of Universities, Cairo, Egypt , Cairo (Egypt)
  • 4 Ministry of Health and Population, Cairo, Egypt , Cairo (Egypt)
  • 5 Ain Shams University Hospitals, Cairo, Egypt , Cairo (Egypt)
  • 6 Alexandria University Hospitals, Alexandria, Egypt , Alexandria (Egypt)
  • 7 Cairo University Hospitals, Cairo, Egypt , Cairo (Egypt)
  • 8 Mansoura University Hospitals, Mansoura, Egypt , Mansoura (Egypt)
  • 9 Assiut University Hospitals, Assiut, Egypt , Assiut (Egypt)
  • 10 Zagazig University Hospital, Benha, Egypt , Benha (Egypt)
Published Article
Antimicrobial Resistance & Infection Control
BioMed Central
Publication Date
Jan 03, 2020
DOI: 10.1186/s13756-019-0639-7
Springer Nature


ObjectiveTo describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system.MethodsDesign: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011–2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13.ResultsThere were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE (p-value = 0.003) and the incidence of CRE HAIs (p-value = 0.09).ConclusionsThis analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU’s .

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