CLINICAL CHARACTERISTICS AND OUTCOMES OF ADULT PATIENTS WITH CARBAPENEM-RESISTANT ENTEROBACTERALES INFECTION IN A TERTIARY CARE HOSPITAL IN KARACHI

Abstract

Background: The global rise of antimicrobial resistance (AMR) has become a critical healthcare challenge, threatening effective treatment of infections. Carbapenem-resistant Enterobacterales (CRE), which include pathogens such as Escherichia coli and Klebsiella pneumoniae, have emerged as significant contributors to morbidity and mortality, particularly in hospitalized patients. These bacteria are resistant to carbapenems, often the last-line antibiotics for multidrug-resistant Gram-negative infections. This study aimed to assess the clinical characteristics and outcomes of CRE infections in hospitalized patients at a tertiary care hospital in Karachi, Pakistan.

Objective: To identify the clinical characteristics of CRE infections and analyze their relationship with clinical outcomes among adult hospitalized patients.

Methods: This cross-sectional study was conducted at The Indus Hospital, Korangi Campus, Karachi, from September 2023 to May 2024. A total of 92 adult patients admitted with CRE infections were included using a non-probability consecutive sampling technique. CRE isolates were obtained from blood, urine, pus, deep tissue, and lung secretions. Species identification and susceptibility testing were performed using the Vitek-2 compact system. Demographics, comorbidities, and clinical parameters, including Sequential Organ Failure Assessment (SOFA) scores, were documented. Data were analyzed using SPSS version 26, with chi-square or Fisher’s exact tests applied to assess significant associations (p<0.05).

Results: Of the 92 patients, 52.2% were male, with a median age of 44.5 years. The most common comorbidities were hypertension (28.3%) and diabetes mellitus (26.1%). The predominant CRE isolates were Escherichia coli (56.5%) and Klebsiella pneumoniae (40.2%). Median hospital stay was 10.5 days, with 88.0% of patients admitted through the emergency room. Mortality occurred in 30.4% of cases, with significant associations identified for chronic liver disease (p=0.048), mechanical ventilation (p<0.001), and high SOFA scores (p<0.001).

Conclusion: CRE infections caused by Klebsiella pneumoniae and Escherichia coli were associated with high mortality despite targeted antimicrobial therapy. Comprehensive AMR strategies, including stewardship and infection control, are essential to mitigate this growing healthcare crisis.