High Acquisition Rate of Gram-Negative Multi-Drug Resistant Organism Colonization During Hospitalization: A Perspective from a High Endemic Setting

Abstract

Objective

The aim of the study was to compare the rate of gram-negative multi-drug resistant organism (GN-MDRO) colonization at admission and during hospitalization and to describe the strains and antibiotic resistance genes acquired during hospitalization.

Methods

Rectal swabs were collected from patients hospitalized at the National Trauma Center (NTC), Mongolia, at the time of admission and after 14 days of hospitalization as has been detailed on our previous study. GN-MDRO antibiotic resistance was determined using EUCAST standards, and resistance genes were detected using multiplex PCR.

Results

A total of 158 patients were screened, and baseline colonization rate at admission was 29.1% (46/158). The rate went up to 69.9% (110/158) after 14 days of hospitalization (p<0.001). Of all participants, 74 patients (46.8%) screened GN-MDRO negative at admission acquired colonization by day 14. Other 36 patients (22.8%) maintained colonization that was screened positive at both time points. Only 38 patients (24.0%) remained free of GN-MDRO during hospitalization. There was a difference in GN-MDRO acquisition between these groups. Patients who were negative at admission acquired up to 3 GN-MDRO species, and there were 10 different species isolated. Reversely, patients who were screened positive at both time points had fairly homogenous isolates; up to 5 species of Enterobacterales were identified at admission and day 14 hospitalization. Overall, Enterobacterales were the dominant colonizers (61.4%, 97/158), and all Enterobacterales were resistant to cefotaxime as CTX-M resistance was our inclusion criteria.

Conclusion

GN-MDRO baseline colonization rate on admission was high and, alarmingly, doubled during hospitalization in the study area. Enterobacterales was the predominant colonizer and was highly resistant to 3rd generation cephalosporin. This data supports a need for an improved infection control policy including routine surveillance of the GN-MDROs and improved antibiotic stewardship program.

Keywords:

• multi-drug resistant organism
• colonization
• antibiotic resistance
• hospital

Acknowledgments

Authors thank the Institute of Medical Microbiology and Hospital Hygiene Dusseldorf for providing consumables and reagents. The authors also thank the PAGEL project coordinators Thomas Bruhn, Wilfried Schwippert and Ulamnemekh Otgonbayar from the Institute of Medical Microbiology and Hospital Hygiene, Dusseldorf, Germany for their continuous support. The project was supported by the Medical Faculty of the Heinrich-Heine-University, Dusseldorf, Germany in collaboration with the ESCMID Study Group on Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland and by the DAAD-PAGEL program (54448058).

Ethics Approval and Consent to Participate

Ethical approval was obtained from the Research Ethics Committee of the Mongolian National University of Medical Sciences (No. 14-15/1A). Informed consent was obtained from all patients (if minor from the parent) participating in the study and the study was conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Prof. Dr. Colin R MacKenzie report grants from German Academic Exchange Service (DAAD), during the conduct of the study. The authors report no other conflicts of interest in this work.