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.