Prevalence and phenotypic characterization of carbapenem resistance in multidrug-resistant Gram-negative bacteria across selected healthcare facilities in the United Arab Emirates: a retrospective study.

BACKGROUND

Carbapenems are essential antibiotics used to treat severe nosocomial infections. However, the misuse of these antibiotics has led to the emergence of carbapenem-resistant organisms (CROs), posing significant public health threats. This study aims to determine the prevalence and phenotypic profile of carbapenem resistance (CR) in multidrug-resistant Gram-negative bacteria (MDR-GNB) in selected healthcare facilities in the United Arab Emirates (UAE).

METHODS

A retrospective study was conducted across 65 healthcare facilities in Dubai and the Northern Emirates (NE) from January 2018 to June 2021. Results from GNB isolates - including Enterobacterales, Acinetobacter, and Pseudomonas aeruginosa- obtained from various clinical samples were collected and assessed for CR using CLSI guidelines at all locations. MDR-CRO prevalence was calculated within each bacterial group using total isolates of that group as the denominator at each time point.

RESULTS

Of the 77,228 GNB collected, 3,829 (5%) MDR-CROs were identified. Within the MDR-CROs subset, Enterobacterales accounted for 65.8% (48.7% of which were Klebsiella pneumoniae), P. aeruginosa 28.6%, and Acinetobacter 5.6%. In contrast, period prevalence calculated within total isolates of each organism group was highest for MDR-CR Acinetobacter (22.8%), followed by MDR-CR P. aeruginosa (12.9%), and MDR-CR Enterobacterales (5.6%). A significant increase in MDR-CR Acinetobacter was observed in the NE in mid-2021, which coincided with the COVID-19 pandemic. Hospitals were the primary source of MDR-CR isolates, accounting for more than 90% of Acinetobacter and P. aeruginosa cases, and 62.6% of Enterobacterales cases. Carbapenems nonsusceptibility varied among bacterial species.

CONCLUSIONS

This study highlights the increasing CR burden of Acinetobacter, P. aeruginosa, and K. pneumoniae in the UAE. Regional variations in resistance, particularly the MDR-CR Acinetobacter surge in the NE during the COVID-19 pandemic, stress the need for tailored infection control measures and antimicrobial stewardship.