Emergence and expansion of carbapenem resistant enterobacterales in the Western Cape Province, South Africa

Background Carbapenem resistant Enterobacterales (CRE) have become established as leading pathogens in South African healthcare facilities. The aim of this study is to describe the epidemiology of CRE carriage and clinical infection episodes at healthcare facilities in the Western Cape Province of South Africa (2016–2020), and identify factors associated with mortality in CRE infected patients. Methodology We used routine data from the Provincial Health Data Centre to track the emergence of CRE in healthcare facilities in the Western Cape Province of South Africa. We included all CRE episodes (clinical and carriage) at Western Cape hospitals (including day and inpatients) from 2016 to 2020 to determine the distribution of CRE, patient demographics and antibiotic resistance phenotypes. Logistic regression was performed to identify factors associated with mortality from clinical CRE episodes. Results 2242 CRE episodes (1580 70.5% clinical and 662 29.5% carriage) were identified. From these, 2281 CRE isolates were identified, with Klebsiella species predominating (1644, 72.1%). Affected patients had a median age of 31 (IQR 0–52) years, and 1167 (52.0%) were male. Most CRE episodes were recorded in central hospitals (70.0%, p 3 days between hospital admission and specimen collection aOR 1.56 (95% CI 1.11–2.18) Conclusions CRE episodes at Western Cape healthcare facilities are concentrated at tertiary hospitals, with high case fatality rates in patients with clinical CRE episodes. Infection control interventions must be strengthened to reduce transmission of CRE, and to reduce infection risks.