Carbapenem-resistant Enterobacterales bacteraemia at a tertiary hospital: A five-year review

Background: Carbapenem-resistant Enterobacterales (CRE) pose a critical threat to public health, marked by limited therapeutic options, high mortality rates and significant pressure on healthcare systems. Despite the growing global burden, our region remains under-represented in national surveillance efforts, with a notable absence of local data. Objectives: This study aims to describe the epidemiological, clinical and microbiological characteristics, as well as patient outcomes, of CRE bacteraemia at Universitas Academic Hospital in Bloemfontein, South Africa, over a 5-year period. Method: A retrospective file review was performed for all adult in-patients with confirmed CRE bacteraemia admitted between 2019 and 2023. Data collected included patient demographics, comorbidities and clinical data pertaining to admission, microbial characteristics and clinical outcomes. Results: Ninety-four episodes of CRE bacteraemia were identified in 88 patients. Prior antibiotic exposure was present in 90.9%, while 79.5% had comorbidities and 61.4% acute renal impairment. Klebsiella pneumoniae (84%) and Enterobacter cloacae (9.6%) were the predominant organisms cultured, with oxacillinase-48 (OXA-48) (78.4%) and New Delhi metallo-β-lactamase (NDM) (6.7%) being the most common carbapenemase genes detected. Only 13.8% of OXA-48-positive episodes received recommended first-line antibiotics. In-hospital mortality reached 56.8%, with immunosuppressive therapy significantly associated with death (p = 0.0165). Conclusion: Mortality in our setting was substantially higher than national and international reports. Suboptimal treatment and limited access to effective antimicrobials likely contributed to these poor outcomes. Contribution: This is the first outcome-focused CRE study in this region, highlighting an urgent need for improved diagnostic capacity, antimicrobial access and targeted intervention strategies in under-resourced healthcare settings.