Assessment of Carbapenem-Resistant Enterobacteriaceae and Other Gram-Negative Bacteria on Intensive Care Unit Surfaces and Among Healthcare Workers at Tobruk Medical Center

Abstract

The emergence of carbapenem-resistant Enterobacteriaceae (CRE) and other multidrug-resistant Gram-negative bacteria (GNB) presents a serious threat to infection control, particularly in high-risk environments such as Intensive Care Units (ICUs). ICU surfaces and healthcare workers (HCWs) may serve as reservoirs and transmission routes for these pathogens. This study aimed to assess the prevalence and distribution of CRE, and other Gram-negative bacteria isolated from ICU environmental surfaces and from the nasal swab of healthcare workers. A descriptive cross-sectional study was used to study 127 collected samples: 36 from healthcare workers and 91 from surface smears. Samples were collected from four units of intensive care: Intensive Care Unit (ICU), Cardiac Care Unit (CCU), Pediatric Care Unit (PICU), and Neonatal Intensive Care Unit (NICU). Identified Enterobacteriaceae were confirmed by biochemical methods, and tested for carbapenemase production using three discs (EME, IMP, ETP). Resistance to Ertapenem, Imipenem, and Meropenem was considered carbapenem resistance. A total of 13 (36.1%) out of 36 HCW samples yielded clinical isolates: 3 Pantoea sp., 3 Klebsiella pneumoniae, 2 Acinetobacter baumannii, 2 Escherichia coli, 2 Flavimonas oriyzihabitans, and 1 Serratia marcescens. One (7.69%) isolate showed carbapenem resistance: 1 Klebsiella pneumonia. From 91 surface samples, 39 (43%) yielded isolates: 13 Flavimonas oriyzihabitans, 6 Acinetobacter baumannii, 5 Pantoea sp., 4 Escherichia coli, 3 Enterobacter cloacae, 2 Serratia marcescens, 2 Shigella sp., 1 Klebsiella pneumonia, 1 Leclercia adecarboxylata, and 1 Salmonella sp. Of these, 11 (28.2%) were carbapenem-resistant: 3 Escherichia coli, 3 Acinetobacter baumannii, 2 Pantoea sp., 1 Klebsiella pneumonia, 1 Citrobacter freundii, and 1 Enterobacter cloacae