Prevalence and antimicrobial resistance of non-ESKAPE-Ec Enterobacteriales in a IV-level hospital in Lima, Peru

Abstract

The aim of this work was to evaluate the levels and the evolution of antimicrobial resistance of non-ESKAPE-Ec Enterobacteriales (NEEcE, non Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli) from a IV-level Peruvian hospital. NEEcE accounting for >0.5% of total isolates in 2009-2010 (Period 1) and/or 2012-2014 (Period 2) were included in the study. Bacterial identification and antimicrobial resistance was performed by automated methods. Additionally, the presence of extended spectrum beta-lactamases (ESBLs) was investigated in Klebsiella oxytoca. According to our results, Citrobacter freundii, Klebsiella oxytoca, Morganella morganii, Proteus mirabilis, Providencia spp. and Serratia marcescens fulfilled inclusion criteria, accounting for 695/9918 isolates (7.0%); 238/3777 (6.30%) in Period 1 and 447/6141 (7.28%) in Period 2 (p=0.0038). P. mirabiliswas the most frequent with 192 isolates (1.94%), while only 54 Providencia spp. (0.54%) were recovered. Carbapenems were the most active antibacterial agents. In general, the microorganisms showed lower or moderate levels of resistance to amikacin and piperacillin/tazobactam, while resistance levels to the remaining antibacterial agents were >40%. Multidrug resistance (MDR) levels varied from 36.1% in S. marcescens to 73.9% in P. mirabilis. Temporal analysis showed that the levels of antibiotic resistance tended to decrease or not to vary. This finding led to a MDR decrease, except for P. mirabilis and Providencia spp. The presence of ESBL was associated with significantly higher levels of resistance to noncephalosporin antibiotics, except imipenem. In conclusion, present results demonstrate the relevance of NEEcE, highlighting the need to include these Enterobacteriales in routine followup and also warn about the worrisome panorama of antibiotic resistance in the area.