World Health Organization priority antimicrobial resistance in <i>Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus</i> and <i>Enterococcus faecium</i> healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational study.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 39957800.
- Also identified by DOI 10.1016/j.lana.2025.101004 and PMC identifier 11830303.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Carbapenem-resistant <i>Enterobacterales</i> (CRE), <i>Acinetobacter baumannii</i> (CRAB), <i>Pseudomonas aeruginosa</i> (CRPA), methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) and vancomycin-resistant <i>Enterococcus faecium</i> (VRE) are listed by World Health Organization (WHO) as priority antimicrobial-resistant bacteria. Data on WHO Priority Antimicrobial resistance Phenotype (WPAP) bacteria from low- and middle-income countries are scarce. In this study, we investigated the occurrence of WPAP in healthcare-associated bloodstream infections (BSI) in Brazil, an upper-middle-income country in South America. ASCENSION was a prospective, multicentre, observational study conducted in 14 hospitals from four of five Brazilian regions. <i>Enterobacterales</i>, <i>A. baumannii</i>, <i>P. aeruginosa, S. aureus</i> and <i>E. faecium</i> BSIs in hospitalised patients were analysed. The primary outcome was the frequency of WPAP among all bacteria of interest. Secondary outcomes were incidence-density of bacteria isolates in hospitalised patients, WPAP proportions within bacterial species, and 28-day mortality. PCR for carbapenemase genes was performed in carbapenem-resistant Gram-negative bacteria. Between August 15, 2022, and August 14, 2023, 1350 isolates (1220 BSI episodes) were included. WPAP accounted for 38.8% (n = 524; 95% Confidence Interval 32.0-46.1) of all isolates, with CRE (19.3%) as the most frequent, followed by CRAB (9.6%), MRSA (4.9%), VRE (2.7%), and CRPA (2.4%). Incidence-density of all and WPAP isolates were 1.91 and 0.77/1000 patients-day, respectively. Carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) was the most common CRE, corresponding to 14.2% of all BSIs. <i>A. baumannii</i> isolates presented the highest proportion of WPAP (87.8%). Mortality rates were higher in patients with BSIs by WPAP than non-WPAP isolates. KPC (64.4%) was the predominant carbapenemase in CRE, followed by NDM (28.4%) and KPC + NDM co-production (7.1%). OXA-23 was the most frequent in CRAB. A high frequency of WPAP bacteria, particularly CRKP and CRAB, were found in healthcare-associated BSIs in Brazil, posing them as a major public health problem in this country. National Council for Scientific and Technological Development, Brazil.