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Epidemiology of CRE in Georgia

#G-2229


Epidemiology of Carbapenem-resistant Enterobacteriaceae in Georgia

Tech Area / Field

  • BIO-MIB/Microbiology/Biotechnology
  • MED-DIS/Disease Surveillance/Medicine

Status
6 Project underway

Registration date
03.11.2015

Senior Project Manager
Asainova S T

Leading Institute
National Center for Diseases Control, Georgia, Tbilisi

Collaborators

  • Lawrence Berkeley National Laboratory, USA, NY, Upton\nNational Center for Global Health and Medicine Hospital, Japan, Toyama\nCardiff University, UK, Cardiff\nUniversiteit Antwerpen, Belgium, Antwerpen\nNational Institute of Infectious Diseases / Special Pathogens Laboratory, Japan, Tokyo

Project summary

Antimicrobial resistance (AMR) is one of our most serious health threats. AMR is a global problem of increasing significance that takes a costly toll on lives and the health-care economy around the world. Untreatable and hard-to-treat infections from carbapenem-resistant Enterobacteriaceae (CRE) bacteria are on the rise among patients in medical facilities. CRE have become resistant to all or nearly all the antibiotics we have today. An estimated 140000 healthcare-associated Enterobacteriaceae infections occur in the US each year; about 9300 of these are caused by CRE. Up to half of all bloodstream infections caused by CRE result in death. The exact prevalence of CRE in healthcare facilities and within the community in Europe is unknown, and publications from Member States and surveillance systems indicate that CRE is endemic in certain countries.

The prevalence and types of CRE in Georgia and the risk factors involved in CRE infections are largely unknown.

We will establish the prevalence and risk factors of CRE in Georgia. We also describe the clinical picture of cases with CRE infection. The collected information and the new capabilities will assist in operational AMR surveillance in Georgia. The information will provide new insight into the mobility of CRE markers through the human populations of the Georgia. This study will allow for appropriate antimicrobial therapy and infection control measures. To identify risk factors for hospital-acquired CRE and community-acquired CRE infections, we will perform a case-control study. Statistical analysis will be carried out using SPSS 20.0. Odds ratios and their 95% CIs will be computed. In the risk factor analysis, multivariate logistic regression models will be used.

Enterobacteriaceae from the clinical samples will be isolated on Endo, MacConkey, or blood agar, and identified using the API20E method; Antimicrobial susceptibility will be tested according to the CLSI recommendations. Carbapenem MICs for imipenem, meropenem, ertapenem, and doripenem will be determined with the Etest. CRE isolates will be screened for the presence of KPC, VIM, IMP, NDM, MOX/CMY and OXA48 in PCR. The plasmids of CRE isolates will be purified by S1-PFGE. The whole nucleotide sequence of the plasmid carrying carbapenemase gene will be determined by the next generation sequencer. Relationship between the plasmids of different isolates will be analyzed by bioinformatics analyses, and epidemiology and spread of carbapenemase genes will be elucidated. These analyses will be done by collaboration between NCDC, Georgia and National Institute of Infectious Diseases and Osaka University Japan.


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