Using an Online Registry of Carbapenemase-Producing Gram-Negative Organisms to Report the Clinical Profile, Outcomes, and Phenotypic and Genotypic Resistances in Two Tertiary Level Hospitals in the Philippines (ORiGiN Study).

BACKGROUND: This study describes the clinical profiles, phenotypic and genotypic resistance mechanisms, and outcomes of patients with carbapenem-resistant infections (CRIs) using a registry. METHODS: Hospitalized adults with CRIs in two tertiary institutions were included in this prospective study from January 1, 2023, to December 31, 2025. RESULTS: A total of 411 patients were included. Half were male (207/411, 50.4%), with median age 59 (range 19-98) years. Hypertension (251, 65.5%), diabetes mellitus (150, 39.2%), and cancer (133, 34.7%) were frequent comorbidities. Of 518 CRIs, half were respiratory (n = 284/518, 49.8%) from ventilator-associated pneumonia (VAP) (163/284, 57.4%) or hospital-acquired pneumonia (HAP) (117/284, 41.2%). Carbapanem-resistant Enterobacterales (CRE) (301/518, 58.1%) and carbapenem-resistant Acinetobacter baumannii (CRAB) (154/518, 29.7%) were the most common pathogens. The majority expressed efflux pumps (388/411, 94.4%). Class B metallo β-lactamase (blaNDM) for CRE and Class D blaOXA-51-like for CRAB were frequent. Overall mortality at the end of hospital stay was 46%. CONCLUSION: Most CRIs in this cohort were CRE and CRAB from HAP/VAP. Organisms possessed multiple mechanisms of resistance, with phenotypic expression of efflux pumps and blaNDM and blaOXA-51-like predominating. High mortality rate was independent of the mechanism of resistance. Novel antimicrobials directed against these specific resistance mechanisms are urgently needed. This registry can be expanded to provide a real-world view of clinical practices.