Prevalence of antimicrobial resistance in gram-negative bacteria bloodstream infections in Peru and associated outcomes: VIRAPERU Study

Fiorella Krapp, Coralith García, Noemi Hinostroza, Lizeth Astocondor, Claudia R Rondon, Brecht Ingelbeen, Hugo A Alpaca-Salvador, Catherine Amaro, Carla Aguado Ventura, Evelyn Barco-Yaipén, Cesar Bocangel Fernandez, Alexander Briones, Antonio Burgos, Rene Campana, Kelly Castillo, Alex Castañeda-Sabogal, Angelica Coaquira, Fátima Concha-Velasco, Edwin Cuaresma Cuadros, Omayra ChinchaJuan Carlos Diaz, Roberto Díaz Sipión, Victor Fernandez, Miguel Hueda-Zavaleta, Enrique López, María Valera-Krumdieck, Rubén Vásquez, Ana María Vidaurre Torres, Miguel Villegas-Chiroque, Favio Sarmiento Lopez, Pedro Alberto Sullón Zavaleta, Elizett Sierra Chavez, Eduardo Paricahua Peralta, Teresa Peralta Córdova, Jimena Edith Pino-Dueñas, Jan Jacobs

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Surveillance of antimicrobial resistance among gram-negative bacteria (GNB) is of critical importance, but data for Peru are not available. To fill this gap, a non-interventional hospital-based surveillance study was conducted in 15 hospitals across Peru from July 2017 to October 2019. Consecutive unique blood culture isolates of key GNB (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp.) recovered from hospitalized patients were collected for centralized antimicrobial susceptibility testing, along with linked epidemiological and clinical data. A total of 449 isolates were included in the analysis. Resistance to third-generation cephalosporins (3GCs) was present in 266 (59.2%) GNB isolates. Among E. coli (n = 199), 68.3% showed 3GC resistance (i.e., above the median ratio for low- and middle-income countries in 2020 for this sustainable development goal indicator). Carbapenem resistance was present in 74 (16.5%) GNB isolates, with wide variation among species (0% in E. coli, 11.0% in K. pneumoniae, 37.0% in P. aeruginosa, and 60.8% in Acinetobacter spp. isolates). Co-resistance to carbapenems and colistin was found in seven (1.6%) GNB isolates. Empiric treatment covered the causative GNB in 63.3% of 215 cases. The in-hospital case fatality ratio was 33.3% (92/276). Pseudomonas aeruginosa species and carbapenem resistance were associated with higher risk of in-hospital death. In conclusion, an important proportion of bloodstream infections in Peru are caused by highly resistant GNB and are associated with high in-hospital mortality.

Original languageEnglish
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number5
Pages (from-to)1095-1106
Number of pages12
Publication statusPublished - 2023


  • Anti-Bacterial Agents/pharmacology
  • Carbapenems
  • Drug Resistance, Bacterial
  • Escherichia coli
  • Gram-Negative Bacteria
  • Gram-Negative Bacterial Infections/drug therapy
  • Hospital Mortality
  • Humans
  • Klebsiella pneumoniae
  • Microbial Sensitivity Tests
  • Peru/epidemiology
  • Prevalence
  • Pseudomonas aeruginosa
  • Sepsis/drug therapy


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