Using an Online Registry of Carbapenemase-Producing Gram-Negative Organisms to Report the Clinical Profile, Outcomes, and Phenotypic and Genotypic Resistances in Two Tertiary Level Hospitals in the Philippines (ORiGiN Study).

BACKGROUND

This study describes the clinical profiles, phenotypic and genotypic resistance mechanisms, and outcomes of patients with carbapenem-resistant infections (CRIs) using a registry.

METHODS

Hospitalized adults with CRIs in two tertiary institutions were included in this prospective study from January 1, 2023, to December 31, 2025.

RESULTS

A total of 411 patients were included. Half were male (207/411, 50.4%), with median age 59 (range 19-98) years. Hypertension (251, 65.5%), diabetes mellitus (150, 39.2%), and cancer (133, 34.7%) were frequent comorbidities. Of 518 CRIs, half were respiratory (n = 284/518, 49.8%) from ventilator-associated pneumonia (VAP) (163/284, 57.4%) or hospital-acquired pneumonia (HAP) (117/284, 41.2%). Carbapanem-resistant Enterobacterales (CRE) (301/518, 58.1%) and carbapenem-resistant Acinetobacter baumannii (CRAB) (154/518, 29.7%) were the most common pathogens. The majority expressed efflux pumps (388/411, 94.4%). Class B metallo β-lactamase (blaNDM) for CRE and Class D blaOXA-51-like for CRAB were frequent. Overall mortality at the end of hospital stay was 46%.

CONCLUSION

Most CRIs in this cohort were CRE and CRAB from HAP/VAP. Organisms possessed multiple mechanisms of resistance, with phenotypic expression of efflux pumps and blaNDM and blaOXA-51-like predominating. High mortality rate was independent of the mechanism of resistance. Novel antimicrobials directed against these specific resistance mechanisms are urgently needed. This registry can be expanded to provide a real-world view of clinical practices.