Secular Trends in Nosocomial Carbapenem-Resistant Enterobacteriaceae (CRE): Twenty-Five Years of Surveillance in Brazilian Hospitals

Abstract

Background: Enterobacteriaceae that develop resistance to carbapenems are a family of different types of bacteria that cause hospital-acquired infections. We evaluated the incidence of nosocomial infections caused by carbapenem-resistant Enterobacteriaceae (CRE) in 13 Brazilian hospitals over 25 years from 1995 to 2019. Methods: CRE was defined as Enterobacteriaceae that is nonsusceptible to any of the a carbapenem (doripenem, meropenem, or imipenem) AND is resistant to all of the following third-generation cephalosporins: ceftriaxone, cefotaxime, and ceftazidime. Hospital-acquired infections (HAIs) were diagnosed according to the CDC NHSN protocols in 13 hospitals from Belo Horizonte, Brazil, between January 1995 to June 2019. Results: In total, 33,922 HAIs caused by Enterobacteriaceae were diagnosed in 25 years across all 13 hospitals. The percentage of CRE varied among hospitals from a minimum of 3% in hospital to a maximum of 30% in hospital E (Fig. 2). The percentage of CRE varied along time as well: for 1995–1999, 0.1% (2 of 1,414) were CRE; for 2000–2004, 0.5% (28 of 5,160) were CRE; for 2005–2009, 2.0% (160 of 8,068) were CRE; for 2010–2014, 11.1% (971 of 8,771) were CRE; and for 2015–2019, 20.2% (2,127 of 10,509) were CRE (Fig. 1). ICU patients and elderly were the most affected by CRE, which has increased lethality, compared to non-CRE Enterobacteriaceae. Conclusions: Over 25 years, CRE percentage increase from almost zero in 1995–1999, to >20% in 2015–2019.Funding: NoneDisclosures: None