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Distribution and Carbapenem Susceptibility of Gram-Negative ESKAPE Pathogens in Hospitalized Patients from Three General Hospitals.

BACKGROUND
Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli) are responsible for the increase of antibiotic-resistant infections across the globe.


METHODS
We retrospectively evaluated the patients infected with Gram-negative ESKAPE pathogens in three tertiary general hospitals (Hospital A, Hospital B, and Hospital C) in Guilin, for the period between January 2014 and December 2018. The data were collected and summarized from the Laboratory Information System (LIS) of the hospital. Antimicrobial susceptibility testing was carried out according to a unified protocol using Vitek 2 compact system.


RESULTS
We collected a total of 16,121 patients with Gram-negative ESKAPE pathogen infections in three hospitals (E. coli, n = 7,142; K. pneumoniae, n = 3,850; P. aeruginosa, n = 2,711; A. baumannii; n = 2,418). Of the Gram-negative ESKAPE pathogens, > 50% of E. coli came from females compared with others. Patients aged above 60 years represented the highest proportion of patients. As observed for E. coli and K. pneumoniae, the sensitivity rates of imipenem and meropenem exceeded 85% in three hospitals, while there was high resistance to imipenem and meropenem for A. baumannii (Hospital A, 51.3%; Hospital B, 56.9%; Hospital C, 43.6%). Especially for Hospital A, rates of extended-spectrum β-lactamase (ESBL) production among E. coli isolates were stable, between 51.2 to 51.5%. On the contrary, the resistance rate of A. baumannii strains to carbapenems increased from 54.8% in 2014 to 60.0% in 2017, but it decreased to 50.4% in 2018.


CONCLUSIONS
Enhanced surveillance of Gram-negative ESKAPE pathogens is critical for selection of appropriate antimicrobial therapy and reducing the incidence of hospital-acquired infections (HAI).