Prevalence of Antimicrobial Resistance in Gram-Negative Bacteria Bloodstream Infections in Peru and Associated Outcomes: VIRAPERU Study

Abstract

Surveillance of antimicrobial resistance among gram-negative bacteria (GNB) is of critical importance, but data for Peru are not available. To fill this gap, a non-interventional hospital-based surveillance study was conducted in 15 hospitals across Peru from July 2017 to October 2019. Consecutive unique blood culture isolates of key GNB (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp.) recovered from hospitalized patients were collected for centralized antimicrobial susceptibility testing, along with linked epidemiological and clinical data. A total of 449 isolates were included in the analysis. Resistance to third-generation cephalosporins (3GCs) was present in 266 (59.2%) GNB isolates. Among E. coli (n = 199), 68.3% showed 3GC resistance (i.e., above the median ratio for low- and middle-income countries in 2020 for this sustainable development goal indicator). Carbapenem resistance was present in 74 (16.5%) GNB isolates, with wide variation among species (0% in E. coli, 11.0% in K. pneumoniae, 37.0% in P. aeruginosa, and 60.8% in Acinetobacter spp. isolates). Co-resistance to carbapenems and colistin was found in seven (1.6%) GNB isolates. Empiric treatment covered the causative GNB in 63.3% of 215 cases. The in-hospital case fatality ratio was 33.3% (92/276). Pseudomonas aeruginosa species and carbapenem resistance were associated with higher risk of in-hospital death. In conclusion, an important proportion of bloodstream infections in Peru are caused by highly resistant GNB and are associated with high in-hospital mortality.

Figure 1.

Enrolled public tertiary care hospitals as sentinel hospitals to the VIRAPERU surveillance study and their location within the 24 regions and 5 macro regions of Peru. The number of hospital beds, time period of participation, number of blood cultures processed, and number of surveilled gram-negative bacteria isolates are presented for each hospital.

Figure 2.

Number of gram-negative bacteria blood isolates recovered from hospitalized patients at sentinel hospitals that met the inclusion criteria and that were analyzed in the present surveillance study.

Figure 3.

Comparison of the cumulative incidence of in-hospital fatalities after blood culture collection (A) between patients with 3GC-resistant and those with nonresistant Escherichia coli bloodstream infections, (B) between carbapenem-resistant and nonresistant GNB bloodstream infections, and (C) between DTR and non-DTR GNB bloodstream infections. 3GC = third-generation cephalosporin; DTR = difficult-to-treat resistance; GNB = gram-negative bacteria.