Carbapenem-resistant organisms in healthcare workers, children and environment in the Center of Care and Protection of Orphan Children, Vietnam

The spreading an infection caused by antimicrobial-resistant (AMR) bacteria is a global public health challenge. Carbapenem antimicrobials are critical for treating patients infected with multi-drug resistant bacteria; however, carbapenem used has also facilitated the selection and spreading of carbapenem-resistant organisms (CROs), mainly found in healthcare settings. Therefore, it hypothesized that CROs may exist and play an essential role in inter-transmission among healthcare workers (HCWs), patients, and the healthcare environment. Hence, the study objectives are to determine the prevalence and risk factors of CRO colonization and determine the genetic background for investigating the potential of clonal spread by CROs. This cross-sectional study performed by collecting the fecal specimens among 20 HCWs, 67 orphan children, and 175 randomly environment specimens between September 2022 and September 2023 at a Center of Care and Protection of Orphaned Children in south of Ho Chi Minh City, Vietnam. The MELAB Chromogenic CARBA agar plates, Card NID, and NMIC-500 CPO of the BD PhoenixTM Automated Microbiology System and whole genome sequencing (WGS) were the tests used to screen, confirm CROs and determine CRO transmission among HCWs, children, and the environment. Statistical analyses were including the descriptive, with frequency, mean and standard deviation. Chi square test was used for identify the association between groups of independents and dependent variables with statistical significant of .05. The Statistical Package for the Social Sciences (SPSS software version 18) was used for data analyses. The performance of WGS for twelve CROs was an essential part of our study. The results found that the prevalence of CROs in HCWs and children was 30.0% (6/20) and 14.92% (10/67), respectively. Most of the CROs in HCWs were CREs, with 20% (4/20). Almost all CROs were Acinetobacter baumannii found in children, but two CREs in a child were Escherichia coli and Klebsiella pneumoniae. The CRO prevalence in the environment was 10.9% (19/175). The risk factors of CRO colonization associated with a group of 20 HCWs and 67 children were HCWs ≥27 years old who have worked ≥ 4 years at the center had the risk of colonized with CROs significantly compared with the remaining group and some other risk factors. WGS demonstrated that E. coli (H006) and E. coli (C4003) were from the resembled clone. Similarly, three isolates of Acinetobacter nosocomialis (C3022, H009, and C3022) were the resembled clone. We also detected the carbapenem resistant genes, including OXA-48 and TEM genes found in E. coli, Enterobacter cloacea, A. baumannii, and A. nosocomialis. In conclusion, the study findings showed that CRO colonization was a problem in the Center for Care and Protection of Orphan Children. CRO transmission was evidenced in HCWs and children through contact between HCWs and children. Hand hygiene, environmental cleaning, and active prevention and control are priorities to prevent CPO colonization among children and HCWs associated with the antibiotic stewardship project.