Antimicrobial susceptibility analysis of gram-negative eskape organisms at Inkosi Albert Luthuli central hospital and Mahatma Gandhi memorial hospital from 2018 to 2022

Abstract

Background: Antimicrobial resistance poses a major challenge to the healthcare system globally due to micro-organisms with the ability to produce enzymes such as Extended-Spectrum Beta-Lactamases (ESBL) and carbapenemase. They have been categorised by the World Health Organisation in 2017 as ESKAPE pathogens, namely Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, to emphasise their importance as global multidrug-resistant priority pathogens. Aim: This study assessed the prevalence and sensitivity profiles of gram-negative ESKAPE pathogens at Inkosi Albert Luthuli Central Hospital and Mahatma Gandhi Memorial Hospital over a five-year period. Methods: Retrospective data were retrieved from the National Health Laboratory service through the Academic Affairs and Research Management Systems. The data was for patients infected by the gram-negative ESKAPE pathogens at Inkosi Albert Luthuli Central and Mahatma Gandhi Memorial Hospital, using analysis for five years. The data were analysed using Microsoft 365 Excel, and the results are presented in tables and figures. Results: A total of 4 781 patient samples from the two hospitals were analysed, of which 27.51% belonged to the 19–30 year age group, with a median average of 42 years. Most were females at 55.33%, and males accounted for 44.34%. A small percentage did not specify their sex. Most pathogens were isolated from urine samples (38.38%) and blood cultures (37.36%). Isolated pathogens were identified as K. pneumoniae (57.31%), A. baumannii complex (18.74%), P. aeruginosa (17.30%) and E. cloacae complex (6.66%). Extended-spectrum Beta-Lactamases-producing microorganisms accounted for only 10.73% of all the isolated pathogens. The highest sensitivity was noted in amikacin (>60%) and carbapenem antimicrobial agents, except for A. baumannii complex. Tigecycline sensitivity was >50% for all pathogens except for P. aeruginosa and colistin sensitivity >70% for both P. aeruginosa and A. baumannii complex. Klebsiella pneumoniae was found to be the most isolated pathogen from all the gram-negative ESKAPE pathogens. These results correlate with results obtained in other studies globally, which report the resistance of K. pneumoniae as causing major infections in the ICU. All these microorganisms were mostly isolated in urine and blood culture samples, proving invasive infections. This did not agree with reports from Iran, where only 8% of K. pneumoniae was noted, but high sensitivity to tigecycline, amikacin and carbapenems. The overall ESBL production for all Enterobacteriaceae was 10.71%. Conclusion: Over the five-year period, 2018 to 2022, infections caused by ESKAPE pathogens increased, and their resistance to beta-lactam and carbapenem antimicrobial agents also increased. Tigecycline and amikacin are still effective, but close monitoring will be needed to prevent the loss of the last effective antimicrobial agent.