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Yamamoto K, Hayashi H, Mizuta K, Fukushima R, Hashimoto K, Nakata H, Hitomi M, Sawa T, Kawaguchi T, Tsutsuki H. Impact of the COVID-19 pandemic on the regional epidemiology of methicillin-resistant Staphylococcus aureus in the Kumamoto region. J Infect Chemother 2025:102743. [PMID: 40449587 DOI: 10.1016/j.jiac.2025.102743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 05/26/2025] [Accepted: 05/28/2025] [Indexed: 06/03/2025]
Abstract
The COVID-19 pandemic caused the collapse of various health systems globally. Several studies have examined the impact of the increase in COVID-19 patients on antimicrobial resistance, but conclusions are controversial. This study aimed to clarify the impact of the COVID-19 pandemic on MRSA trends in the Kumamoto region. We analyzed the detection trends of MRSA using bacterial surveillance data from facilities in the Kumamoto Healthcare-associated Infection Prevention and Control Network from 2017 to 2022. Compared to pre-pandemic data, MRSA detection rates since 2020 have decreased. This was thought to be due to a decrease in the number of bacteriological tests of respiratory specimens, in which MRSA was frequently detected before the pandemic. On the other hand, that of skin and soft tissue specimens were not affected by the pandemic. The MRSA detection rate in these specimens showed a downward trend, suggesting that the increased awareness of infection control measures, including hand hygiene the enforcement of hand hygiene during the pandemic possibly had an impact. We further performed POT method analysis using a clinically isolated MRSA library from Kumamoto University Hospital. The monthly detection rate of the predominant POT type fluctuated from FY2020 to FY2022, and this clonal shift may have contributed to the decline in the MRSA detection rate in the Kumamoto region during the pandemic period. Throughout the pandemic, MRSA clones continued to evolve. Notably, the prevalence of clone 106-247-33, which was dominant in the early phase, may have fluctuated, potentially in relation to variations in the stringency of infection control measures. Our study showed that a decrease in detection rates from specific specimens and a clonal shift in MRSA were observed in the Kumamoto region during the pandemic. Therefore, further reductions in MRSA can be expected with maintaining robust implementation of infection control.
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Affiliation(s)
- Keiichi Yamamoto
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan; Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideyuki Hayashi
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan; Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
| | - Kanako Mizuta
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Rika Fukushima
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan; Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenyu Hashimoto
- Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto, Japan
| | - Hirotomo Nakata
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
| | - Maeda Hitomi
- Department of Nursing, Graduate School of Health Sciences, Faculty of Haelth Sciences, Kumamoto Health Science University, Kumamoto, Japan
| | - Tomohiro Sawa
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tatsuya Kawaguchi
- Department of Medical Technology, Faculty of Health Science, Kumamoto Health Science University, Kumamoto, Japan
| | - Hiroyasu Tsutsuki
- Department of Microbiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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2
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Wang D, Duan Y, He L, Jiang J, Xian J, Yuan K, Zhang R, Zhang H, Wang J, Li N, Huang M, Hu C, Lu S, Luo Z, Deng T, Zhang Z, Chen B, Li W. Altered microbiota of the lower respiratory tract and its association with COVID-19 severity analysed by metagenomics and metatranscriptomics. Commun Biol 2025; 8:804. [PMID: 40419790 DOI: 10.1038/s42003-025-08234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 05/15/2025] [Indexed: 05/28/2025] Open
Abstract
The interaction between gut and oropharyngeal microbiota plays a significant role in the viral infections like SARS-CoV-2, but role of the lower respiratory tract microbiota remains unclear. Our study utilized metatranscriptomics and metagenomics to analyze the microbial composition of bronchoalveolar lavage fluid and sputum samples from 116 COVID-19 patients, categorized into mild, severe, and critical groups. Our analysis revealed significant differences in viral genotypes across disease stages. As disease severity increased, the Chao index also rose. The mild group was predominantly dominated by Firmicutes, while the severe group showed an increase in Bacteroidetes. The critical group was characterized by a higher abundance of Actinobacteria and Proteobacteria. Notably, the abundance of Streptococcus and Rothia decreased as the disease progressed. Additionally, the Shannon index correlated with mortality risk, while the Chao index was associated with ICU admission, mechanical ventilation, and patient survival. These findings highlight the strong link between microbial composition and COVID-19 severity, providing valuable insights for assessing disease progression.
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Affiliation(s)
- Denian Wang
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Yishang Duan
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Juan Jiang
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jinghong Xian
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Rui Zhang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huohuo Zhang
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Wang
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | | | - Chenggong Hu
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, No. 2222, Frontier Medical Center, Xin Chuan Road, Zhong He Street, Chengdu, Sichuan, People's Republic of China
| | - Sifeng Lu
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiheng Luo
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Taibing Deng
- Department of Respiratory Medicine, Guang'an People'hospital, Guang'an, Sichuan, China.
| | - Zhongwei Zhang
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, No. 2222, Frontier Medical Center, Xin Chuan Road, Zhong He Street, Chengdu, Sichuan, People's Republic of China.
| | - Bojiang Chen
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Precision Medicine Research Center, Precision Medicine Key Laboratory of Sichuan Province, State Key Laboratory of Respiratory Health and Multimorbidity, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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3
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Yan X, Tao R, Zhou H, Zhang Y, Chen D, Ma L, Bai Y. Sublethal sanitizers exposure differentially affects biofilm formation in three adapted Salmonella strains: A phenotypic-transcriptomic analysis of increased biofilm formed by ATCC 14028. Int J Food Microbiol 2025; 436:111189. [PMID: 40222328 DOI: 10.1016/j.ijfoodmicro.2025.111189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 03/27/2025] [Accepted: 04/02/2025] [Indexed: 04/15/2025]
Abstract
PURPOSE Using sanitizer in food industry is an important mean of sterilization and biofilm eradication, but inappropriate operation may lead to resistance, posing a concealed risk to food safety. The purpose of this study was to assess the impact of sub-lethal sanitizers on the biofilm formed by adaptive Salmonella and to explore the variations in transcription within adaptive Salmonella biofilms when co-incubated with sublethal concentrations of sanitizers. METHODS The microbroth dilution method was determined to measure the MIC of three sanitizers on Salmonella, and adaptation induction was conducted with steadily increasing sanitizer concentrations. The effect of sub-MIC sanitizers on the biofilm of Salmonella was investigated by crystal violet method, confocal laser scanning microscopy and transcriptomics. RESULTS The results indicated that the maximum growth concentration of the adapted strains was 1.69-43.25 times that of the original MIC, and the number of bacteria and matrix content were increased when re-exposed to sub-MIC benzalkonium chloride (BZK), and the expression of regulatory factors and various amino acid biosynthesis and metabolism-related genes showed an up-regulation trend. SIGNIFICANCE This will be beneficial to clarify the correlation and mechanism between the sanitizer adaptation of salmonellae caused by improper sanitization and increased biofilm formation resulting from this adaptation. And it helps to adjust the appropriate dosage of sanitizer and optimize sanitation standard operating procedures (SSOP) in the foodstuff industry, thereby effectively promoting the bactericidal effect and eliminating foodborne pathogens' biofilm.
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Affiliation(s)
- Xiaoxue Yan
- College of Food Science, Southwest University, 2 Tiansheng Rd, Beibei, Chongqing 400715, PR China.
| | - Rongfeng Tao
- College of Food Science, Southwest University, 2 Tiansheng Rd, Beibei, Chongqing 400715, PR China.
| | - Hongyuan Zhou
- College of Food Science, Southwest University, 2 Tiansheng Rd, Beibei, Chongqing 400715, PR China; Chongqing Key Laboratory of Specialty Food Co-Built by Sichuan and Chongqing, Chongqing 400715, PR China.
| | - Yuhao Zhang
- College of Food Science, Southwest University, 2 Tiansheng Rd, Beibei, Chongqing 400715, PR China; Chongqing Key Laboratory of Specialty Food Co-Built by Sichuan and Chongqing, Chongqing 400715, PR China; Key Laboratory of Condiment Supervision Technology for State Market Regulation, Chongqing 401121, PR China; Key Laboratory of Luminescence Analysis and Molecular Sensing (Southwest University), Ministry of Education, Chongqing 400715, PR China.
| | - Dong Chen
- College of Food Science, Southwest University, 2 Tiansheng Rd, Beibei, Chongqing 400715, PR China.
| | - Liang Ma
- College of Food Science, Southwest University, 2 Tiansheng Rd, Beibei, Chongqing 400715, PR China; Chongqing Key Laboratory of Specialty Food Co-Built by Sichuan and Chongqing, Chongqing 400715, PR China; Key Laboratory of Condiment Supervision Technology for State Market Regulation, Chongqing 401121, PR China.
| | - Yamin Bai
- Key Laboratory of Condiment Supervision Technology for State Market Regulation, Chongqing 401121, PR China; Chongqing Institute for Food and Drug Control, Chongqing 401121, PR China
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Baek JW, Lim S, Park N, Song B, Kirtipal N, Nielsen J, Mardinoglu A, Shoaie S, Kim JI, Son JW, Koh A, Lee S. Extensively acquired antimicrobial-resistant bacteria restructure the individual microbial community in post-antibiotic conditions. NPJ Biofilms Microbiomes 2025; 11:78. [PMID: 40360555 PMCID: PMC12075632 DOI: 10.1038/s41522-025-00705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 04/15/2025] [Indexed: 05/15/2025] Open
Abstract
In recent years, the overuse of antibiotics has led to the emergence of antimicrobial-resistant (AMR) bacteria. To evaluate the spread of AMR bacteria, the reservoir of AMR genes (resistome) has been identified in environmental samples, hospital environments, and human populations, but the functional role of AMR bacteria and their persistence within individuals has not been fully investigated. Here, we performed a strain-resolved in-depth analysis of the resistome changes by reconstructing a large number of metagenome-assembled genomes from the gut microbiome of an antibiotic-treated individual. Interestingly, we identified two bacterial populations with different resistome profiles: extensively acquired antimicrobial-resistant bacteria (EARB) and sporadically acquired antimicrobial-resistant bacteria, and found that EARB showed broader drug resistance and a significant functional role in shaping individual microbiome composition after antibiotic treatment. Our findings of AMR bacteria would provide a new avenue for controlling the spread of AMR bacteria in the human community.
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Grants
- 2021R1C1C1006336, 2021M3A9G8022959, RS-2024-00419699 National Research Foundation of Korea
- 2021R1C1C1006336, 2021M3A9G8022959, RS-2024-00419699 National Research Foundation of Korea
- 2021R1C1C1006336, 2021M3A9G8022959, RS-2024-00419699 National Research Foundation of Korea
- 2021R1C1C1006336, 2021M3A9G8022959, RS-2024-00419699 National Research Foundation of Korea
- 2021R1C1C1006336, 2021M3A9G8022959, RS-2024-00419699 National Research Foundation of Korea
- 2021R1C1C1006336, 2021M3A9G8022959, RS-2024-00419699 National Research Foundation of Korea
- HR22C141105 the Korea Health Industry Development Institute
- HR22C141105 the Korea Health Industry Development Institute
- HR22C141105 the Korea Health Industry Development Institute
- HR22C141105 the Korea Health Industry Development Institute
- HR22C141105 the Korea Health Industry Development Institute
- HR22C141105 the Korea Health Industry Development Institute
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- 2024-ER2108-00, 2024-ER0608-00 Korea National Institute of Health
- GIST-MIT research Collaboration grant GIST Research Institute
- GIST-MIT research Collaboration grant GIST Research Institute
- GIST-MIT research Collaboration grant GIST Research Institute
- GIST-MIT research Collaboration grant GIST Research Institute
- GIST-MIT research Collaboration grant GIST Research Institute
- GIST-MIT research Collaboration grant GIST Research Institute
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Affiliation(s)
- Jae Woo Baek
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Songwon Lim
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Nayeon Park
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Byeongsop Song
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Nikhil Kirtipal
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Jens Nielsen
- Department of Biology and Biological Engineering, Kemivägen 10, Chalmers University of Technology, Gothenburg, Sweden
- BioInnovation Institute, Copenhagen, Denmark
| | - Adil Mardinoglu
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Science for Life Laboratory, KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Saeed Shoaie
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Jae-Il Kim
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Jang Won Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ara Koh
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, South Korea
| | - Sunjae Lee
- Department of Life Sciences, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea.
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5
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Butscheid Y, Frey PM, Pfister M, Pagani L, Kouyos RD, Scheier TC, Staiger WI, Mancini S, Brugger SD. Decline of antimicrobial resistance in Pseudomonas aeruginosa bacteraemia following the COVID-19 pandemic: a longitudinal observational study. J Antimicrob Chemother 2025:dkaf136. [PMID: 40366637 DOI: 10.1093/jac/dkaf136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 04/22/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Understanding the effects of changes brought by the COVID-19 pandemic on antimicrobial resistance in P. aeruginosa (PA) is essential to inform clinical management. METHODS This single-centre retrospective cohort study included adult inpatients with PA bacteraemia at the University Hospital Zurich between January 2014 and December 2023. The primary outcome was the association between the start of the COVID-19 pandemic and PA with multidrug resistance (MDR), defined as resistance to ≥3 of 5 antibiotic classes. We used logistic regression to adjust for age, sex and ICU treatment. Secondary outcomes included changes in resistance patterns, patient demographics and antimicrobial consumption. RESULTS A total of 493 instances of PA bacteraemia in 333 patients were observed during the study period. The proportion of MDRPA declined from 21% (62/291) pre-pandemic to 9% (19/202) post-pandemic (adjusted OR 0.38, 95% CI 0.18-0.79, p = 0.01). The occurrence of MDRPA during hospitalization following an initial instance of non-MDRPA bacteraemia was rare and unlikely to happen earlier than after 2 weeks. After the start of the pandemic, we observed no MDRPA cases involving cardiovascular or pulmonary diseases and marked reductions in patients with burn injuries or organ transplants. Furthermore, ciprofloxacin and tobramycin use significantly decreased after the start of the pandemic. Overall in-hospital mortality among patients with MDRPA bacteraemia remained high (28%), with no substantial differences between time periods. CONCLUSION We observed a decline in MDRPA occurrence after the start of the COVID-19 pandemic, possibly driven by intensified infection control measures, shifts in antimicrobial use and changes in patient populations.
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Affiliation(s)
- Yulia Butscheid
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pascal M Frey
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Marc Pfister
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lisa Pagani
- Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Willy I Staiger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefano Mancini
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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6
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Peconi C, Martini E, Sarti D, Prospero E. Impact of the COVID-19 pandemic on healthcare-associated infections and multidrug-resistant microorganisms in Italy: A systematic review. J Infect Public Health 2025; 18:102729. [PMID: 40056892 DOI: 10.1016/j.jiph.2025.102729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 02/03/2025] [Accepted: 02/27/2025] [Indexed: 03/10/2025] Open
Abstract
BACKGROUND The diffused and prolonged SARS-CoV-2 transmission lead to high levels of hospitalization. During this period, the focus of sanitary structures was to contain COVID-19 mortality and this may have reduced the application of health associated infection (HAI) and multidrug resistant microorganism (MDRO) prevention programs. METHODS A search was performed in PubMed, Science Direct, and Google Scholar databases to identify clinical observational studies that reported the impact of COVID-19 pandemic on the prevalence or incidence on HAIs and/or MDROs from December 2019 to August 2024 in Italy. Studies were included if they reported a comparison with pre-pandemic period and had a full-text available. Eligible studies were assessed for risk of bias and quality with NHI Quality Assessment Tool by two researchers independently. Data were represented in tables and a narrative synthesis was made in the text. RESULTS Selected studies included 4 studies reporting data on HAI (1497 total patients) and 11 studies reporting data on MDRO (80388 total patients). The majority of the studies reported an increase in HAI prevalence (9-11.1 % range) and MDRO, in particular, gram negative MDRO had an increase range of 0.8 %-45.6 % and gram positive MDRO an increase range of 0.5 %-81.8 % from pre- to post-COVID-19 period in the different studies considered CONCLUSION: These findings underscore the critical need for active surveillance in hospital wards, the implementation of antibiotic stewardship and prescribing programs to mitigate the impact of such crises on healthcare-associated infections and antimicrobial resistance. Furthermore, permanent training of healthcare personnel is necessary.
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Affiliation(s)
- Chiara Peconi
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Enrica Martini
- Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | - Donatella Sarti
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
| | - Emilia Prospero
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy; Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
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7
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Vulcanescu DD, Bagiu IC, Dragomir TL, Sorop VB, Diaconu M, Harich O, Tanasescu SA, Szasz F, Vlaicu L, Goian C, Horhat FG. The Impact of the COVID-19 Pandemic on Pediatric Microbial Resistance Patterns and Abandonment Rates in Western Romania-An Interdisciplinary Study. Antibiotics (Basel) 2025; 14:411. [PMID: 40298574 PMCID: PMC12024448 DOI: 10.3390/antibiotics14040411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2025] [Revised: 04/07/2025] [Accepted: 04/14/2025] [Indexed: 04/30/2025] Open
Abstract
Background: The COVID-19 pandemic in Romania exacerbated pediatric antimicrobial resistance (AMR). Overuse of broad-spectrum antibiotics may be related to increased multidrug-resistant bacteria. The main aim of this study was to assess pediatric AMR trends and phenotypes, while a secondary objective was to investigate the potential links with hospital abandonment. Methods: This retrospective study from the Children's Emergency Hospital "Louis Țurcanu", Timișoara, focused on AMR patterns in 2019 pre-pandemic, 2021 pandemic, and 2023 post-pandemic. The following phenotypes were assessed: MRSA, MRCoNS, VRE, ESBL, CRO, MDR, XDR, and PDR. Results: There were 3530 total patients and 6885 total samples. There were 69.92% of the total samples resistant to at least one antimicrobial class, (72.69% in 2019, 67.05% in 2021, 69.16% in 2023). Specifically, resistance towards penicillins remained high across the entire period (57.45-60.93%), while the following classes presented elevated resistance in the pandemic: cephalosporins (42.91%), combination therapies (40.95%), reserve antibiotics (38.89%), and cyclines (13.83%). As for resistance phenotypes, MRSA and MRCoNS peaked during the pandemic (36.08% and 81.43%, respectively) while VRE remained relatively constant. Overall ESBL declined in 2023 to 14.45%, while overall CRO peaked during the pandemic (8.81%). Overall MDR fell during the pandemic (64.47%), while overall XDR peaked in 2019 (9.87%). No PDR cases were observed. Pediatric abandonment was an increasing concern, with regional cases rising from 5.42% (2019) to 9.83% (2023). Compared to the general population, increased antimicrobial resistance in abandoned patients was observed for fluoroquinolones (50.00%), Aminogycolsides (60.00%), reserve antibiotics (70.00%), cephalosporins (60.00%), and urinary antibiotics (60.00%). Resistance to cephalosporins (OR = 5.17, p = 0.0304) and reserve antibiotics (OR = 5.64, p = 0.0049) were key predictors of abandonment risk. Conclusions: The COVID-19 pandemic influenced resistance trends, with notable peaks in MRSA, MRCoNS, and CRO. Post-pandemic patterns suggest continued escalation of resistance. The association between resistant infections and pediatric abandonment highlights the need for robust antimicrobial stewardship and social intervention policies.
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Affiliation(s)
- Dan Dumitru Vulcanescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (I.C.B.); (F.G.H.)
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Clinical Laboratory, “Louis Turcanu” Emergency Hospital for Children, Timisoara, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Iulia Cristina Bagiu
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (I.C.B.); (F.G.H.)
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Clinical Laboratory, “Louis Turcanu” Emergency Hospital for Children, Timisoara, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
| | - Tiberiu Liviu Dragomir
- Medical Semiology II Discipline, Internal Medicine Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Virgiliu Bogdan Sorop
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (V.B.S.); (M.D.)
| | - Mircea Diaconu
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (V.B.S.); (M.D.)
| | - Octavia Harich
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Sonia Aniela Tanasescu
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Florin Szasz
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Luiza Vlaicu
- Department of Social Assistance, Faculty of Sociology and Psychology, Western University, Vasile Parvan Boulevard 4, 300223 Timisoara, Romania; (L.V.); (C.G.)
| | - Cosmin Goian
- Department of Social Assistance, Faculty of Sociology and Psychology, Western University, Vasile Parvan Boulevard 4, 300223 Timisoara, Romania; (L.V.); (C.G.)
| | - Florin George Horhat
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (I.C.B.); (F.G.H.)
- Multidisciplinary Research Center on Antimicrobial Resistance (MULTI-REZ), Microbiology Department, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Clinical Laboratory, “Louis Turcanu” Emergency Hospital for Children, Timisoara, Iosif Nemoianu Street 2, 300011 Timisoara, Romania
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Zomorodi AR, Salimizand H, Mohseni N, Hafiz M, Nikoueian H, Gholamhosseini-Moghaddam T, Aflakian F. Genomic Characterization of NDM-1 Harboring Extensively-Drug Resistance Klebsiella pneumoniae Isolate From ICU-Admitted Patient With COVID-19. J Trop Med 2025; 2025:6616950. [PMID: 40260410 PMCID: PMC12011471 DOI: 10.1155/jotm/6616950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Accepted: 03/28/2025] [Indexed: 04/23/2025] Open
Abstract
Currently, carbapenem-resistant Klebsiella pneumoniae (CR-KP) strains, particularly those producing New Delhi metallo-beta-lactamase (NDM), are increasingly recognized as a significant threat to global health. The present study aimed to conduct a genomic analysis of an NDM-1-producing CR-KP strain isolated from patients with coronavirus disease of 2019 (COVID-19) admitted to the intensive care unit (ICU). The K. pneumoniae isolate was obtained from the bronchoalveolar lavage fluid of a 68 year-old male patient hospitalized in the ICU with COVID-19 at Besat Hospital in Sanandaj, Iran. The minimum inhibitory concentrations (MICs) for 15 antibiotics were determined using the VITEK 2 system. Genomic analysis of the isolate was performed using whole genome sequencing. The CRKP-51 strain was identified as an extensively drug-resistant (XDR) strain, exhibiting resistance to all tested antibiotics except tigecycline (MIC = 2 μg/mL). The highest resistance values were recorded against sulfamethoxazole-trimethoprim (SXT), nitrofurantoin (NIT), and piperacillin-tazobactam (TZP), with MICs of ≥ 320, 256 μg/mL, and ≥ 128 μg/mL, respectively. Multilocus sequence typing revealed that CRKP-51 belonged to sequence type 15 (ST15). The IncHI1B replicon type associated with this strain harbored several resistance genes, including bla NDM-1 , armA, msrE, mphE, BRP (MBL), bla OXA-1, aadA2, dfrA12, qnrB1, bla CTX-M-15, and cat1. High-risk K. pneumoniae clones, such as ST15, are increasingly associated with antimicrobial resistance and the emergence of XDR strains in ICUs. Additionally, the global dissemination of the NDM enzyme occurs through various plasmid replicon types. Therefore, monitoring local epidemiology is essential for the effectiveness of antimicrobial stewardship programs.
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Affiliation(s)
- Abolfazl Rafati Zomorodi
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Himen Salimizand
- Vaccine and Infectious Disease Organization, Saskatoon, Saskatchewan, Canada
- Department of Vaccinology and Immunotherapeutics, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Niloufar Mohseni
- Department of Pathobiology, School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Maryam Hafiz
- Department of Pathobiology, School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Helia Nikoueian
- Department of Pathobiology, School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Fatemeh Aflakian
- Department of Pathobiology, School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
- Department of Chemical Engineering, Faculty of Advanced Technology, Quchan University of Technology, Quchan, Iran
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9
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Kong Y, Liu T, Zhang Y, Wang H, Lin H. Investigation of an outbreak of carbapenem resistant Acinetobacter baumannii in an intensive care unit during the COVID-19 epidemic. Antimicrob Resist Infect Control 2025; 14:30. [PMID: 40221801 PMCID: PMC11994003 DOI: 10.1186/s13756-025-01547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 03/28/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) epidemic, the strain on intensive care units (ICUs) has increased, which made them more vulnerable to the threat of multidrug-resistant organism (MDRO). AIM This study aims to investigate an outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) infection in a general adult ICU of a tertiary hospital in China during the COVID-19 epidemic and evaluate the effectiveness of intervention measures. METHODS Demographic and clinical data of 37 patients were collected, and 230 environmental samples were collected. Whole genome sequencing (WGS) analysis was performed on clinical and environmental isolates. An evolutionary tree was constructed based on the WGS data. The infection control team implemented a bundle of MDRO interventions, including a termination of COVID-19 infection control measures and implementation of 'three-step' cleaning and disinfection method. FINDINGS There were 37 patients found to have CRAB infection or colonization in the ICU from December 2022 to April 2023, of whom 35 were hospital-acquired. 12 CRAB isolates were obtained from the environment and medical equipment. Through WGS analysis, the CRAB strains from the medical environment and bronchoscopes were found to be highly homologous to those from patients' clinical specimens. This demonstrated that the infection outbreak was caused by the lack of MDRO prevention and control measures. Following intervention, the CRAB detection rate gradually declined, with no positive samples for CRAB found in the ICU environment or on bronchoscopes. CONCLUSION The infection control measures for COVID-19 conflicted with basic MDRO prevention and control strategies, likely contributing to the outbreak. Therefore, established infection prevention and control measures should be consistently followed, as they represent the most effective approach to preventing MDRO.
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Affiliation(s)
- Yi Kong
- Department of Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road, 321#, Gulou District, Nanjing City, Jiangsu Province, 210008, PR China
| | - Ting Liu
- Department of Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road, 321#, Gulou District, Nanjing City, Jiangsu Province, 210008, PR China
| | - Yanru Zhang
- Department of Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road, 321#, Gulou District, Nanjing City, Jiangsu Province, 210008, PR China
| | - Hui Wang
- Department of Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road, 321#, Gulou District, Nanjing City, Jiangsu Province, 210008, PR China
| | - Hongyi Lin
- Department of Infection Control, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road, 321#, Gulou District, Nanjing City, Jiangsu Province, 210008, PR China.
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10
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Saeed NK, Almusawi SK, Albalooshi NA, Al-Beltagi M. Unveiling the impact: COVID-19's influence on bacterial resistance in the Kingdom of Bahrain. World J Virol 2025; 14:100501. [PMID: 40134836 PMCID: PMC11612879 DOI: 10.5501/wjv.v14.i1.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 10/22/2024] [Accepted: 11/15/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Antibiotic resistance is a growing global health threat, and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship. The coronavirus disease 2019 (COVID-19) pandemic has introduced additional complexities, potentially influencing these patterns. AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023, with a specific focus on the impact of the COVID-19 pandemic on these trends. METHODS A retrospective analysis of microbiological data was conducted, covering the period from 2018 to 2023. The study included key bacterial pathogens such as Escherichia coli (E. coli), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus, among others. The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods. To contextualize the findings, the findings were compared with similar studies from other regions, including China, India, Romania, Saudi Arabia, the United Arab Emirates, Malaysia, and United States. RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates, with notable changes during the COVID-19 pandemic. For example, a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years, while the prevalence of E. coli showed a more variable pattern. Antibiotic resistance rates varied among the different pathogens, with a concerning rise in resistance to commonly used antibiotics, particularly among Klebsiella pneumoniae and E. coli. Additionally, the study identified an alarming increase in the prevalence of multidrug-resistant (MDR) strains, especially within Klebsiella pneumoniae and E. coli isolates. The impact of the COVID-19 pandemic on these trends was evident, with shifts in the frequency, resistance patterns, and the emergence of MDR bacteria among several key pathogens. CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex, particularly in the context of the COVID-19 pandemic. The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance. Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.
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Affiliation(s)
- Nermin K Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 12, Bahrain
- Medical Microbiology Section, Department of Pathology, Royal College of Surgeons in Ireland–Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Safiya K Almusawi
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 12, Bahrain
- Medical Microbiology Section, Department of Pathology, Royal College of Surgeons in Ireland–Medical University of Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Noor A Albalooshi
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Governmental Hospitals, Manama 12, Bahrain
| | - Mohammed Al-Beltagi
- Department of Paediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Alghrabia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Algharbia, Bahrain
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11
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Randag AC, Wellens L, Kazemian N, Schimmer B, van Rooij J. Microbial Keratitis Before, During and After the COVID-19 Pandemic, and the Role of Contact Lens Wear and Hand Hygiene. Clin Ophthalmol 2025; 19:1033-1043. [PMID: 40134777 PMCID: PMC11934872 DOI: 10.2147/opth.s512671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 02/20/2025] [Indexed: 03/27/2025] Open
Abstract
Introduction During the COVID-19 pandemic, there was a significant decline in the number of patients with both non-urgent and urgent ophthalmologic conditions presenting to emergency departments, leading to concerns about the whereabouts of patients in need of care. We hypothesized that there was an actual decrease in microbial keratitis (MK) cases, due to reduced contact lens (CL) wear and improved hand hygiene, including alcohol-based hand disinfection. Besides, we questioned if non-pharmaceutical interventions would have a sustained effect after the COVID-19 pandemic. Methods Retrospectively, characteristics of patients presenting with MK at a large ophthalmic tertiary referral center were compared during 9 March-15 June of 2018 and 2019 ("pre-COVID"), 2020 ("COVID") and 2022 and 2023 ("post-COVID"). In an online cross-sectional survey among CL wearers, CL wear and hand hygiene habits were compared for the recall months February and April 2020. Results Three hundred and one MK patients were included: 79 in 2018, 69 in 2019, 41 in 2020, 60 in 2022 and 52 in 2023. Presentation delay was ≥4 days in 38% during COVID, compared to 54% pre-COVID (p = 0.106). The proportion of CL related MK did not differ (p = 0.704). Fewer patients were admitted than pre-COVID (p = 0.026), without a difference in admission indications (p = 0.322). Pseudomonas aeruginosa and Staphylococcus aureus cases were not observed during COVID. Post-COVID, MK by Pseudomonas aeruginosa occurred more often than pre-COVID (p < 0.001). In the online survey with 791 respondents, hand washing before CL insertion and removal and hand disinfection were reported more often in April 2020 than February 2020 (respectively, p = 0.001, p < 0.001 and p < 0.001). Conclusion We found no evidence of MK patients facing barriers to accessing hospital care during the COVID-19 pandemic, as presentation delays were not longer and cases not more severe. Our data suggest that a decreased MK incidence may be due to improved hand hygiene practices, including alcohol-based hand disinfection.
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Affiliation(s)
- Anna C Randag
- Department of Cornea and Anterior Segment Disease, Rotterdam Eye Hospital, Rotterdam, The Netherlands
- Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands
| | - Liesbeth Wellens
- Department of Cornea and Anterior Segment Disease, Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Nelly Kazemian
- Department of Cornea and Anterior Segment Disease, Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Barbara Schimmer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeroen van Rooij
- Department of Cornea and Anterior Segment Disease, Rotterdam Eye Hospital, Rotterdam, The Netherlands
- Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands
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12
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Wan K, Liu Y, Chen Y, Sun S, Liang H. Hemophagocytic Lymphohistiocytosis Secondary to Melioidosis in Paediatric Patients: A Case Series. Infect Drug Resist 2025; 18:1561-1566. [PMID: 40129908 PMCID: PMC11930841 DOI: 10.2147/idr.s505259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 03/06/2025] [Indexed: 03/26/2025] Open
Abstract
Background Melioidosis caused by Burkholderia pseudomallei manifests as a variety of infectious symptoms. However, hemophagocytic lymphohistiocytosis (HLH) secondary to bacteraemic melioidosis is rarely documented in the literature. We report a series of fatal cases of melioidosis combined with HLH in one Chinese family. Case Presentation Three cases of melioidosis with HLH were reported in a family with three children, two boys aged 4 and 6 years and a 12-year-old girl. The most common clinical presentation was fever. A blood culture confirmed B. pseudomallei, and bone marrow aspiration revealed hemophagocytosis. Despite the administration of antibiotics, glucocorticoids and other treatments, all the patients died, and their deaths were attributed to HLH. Conclusion Melioidosis complicating HLH is rare in occurrence, but the mortality rate is high. Clinicians should be aware of the risk of a B. pseudomallei bloodstream infection in children.
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Affiliation(s)
- Kecheng Wan
- Department of Paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People’s Republic of China
| | - Yingjie Liu
- Department of Paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People’s Republic of China
| | - Yuwen Chen
- Department of Paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People’s Republic of China
| | - Song Sun
- Department of Paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People’s Republic of China
| | - Hong Liang
- Department of Paediatrics, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, People’s Republic of China
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Shi Q, Mao D, Zhang Z, Qudsi AI, Wei M, Cheng Z, Zhang Y, Wang Z, Chen K, Xu X, Lu X, Liang Q. Epidemiological and Antimicrobial Resistance Trends in Bacterial Keratitis: A Hospital-Based 10-Year Study (2014-2024). Microorganisms 2025; 13:670. [PMID: 40142562 PMCID: PMC11945485 DOI: 10.3390/microorganisms13030670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/05/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025] Open
Abstract
Bacterial keratitis (BK) is a severe ocular infection that can lead to vision loss, with antimicrobial resistance (AMR) posing a growing challenge. This study retrospectively analyzed 1071 bacterial isolates from corneal infections over a 10-year period (2014-2024) at a tertiary ophthalmic center in Beijing, categorizing them into three distinct phases: pre-COVID-19, during COVID-19, and post-COVID-19. The results indicated significant changes in pathogen distribution, including a marked decrease in Gram-positive cocci (from 69.8% pre-COVID-19 to 49.3% in post-COVID-19, p < 0.001), particularly in Staphylococcus epidermidis. In contrast, Gram-positive bacilli, particularly Corynebacterium spp., increased from 4.2% to 16.1% (p < 0.001). The susceptibility to gatifloxacin, moxifloxacin, and ciprofloxacin significantly declined in both Gram-positive cocci and bacilli during the COVID-19 period (all p < 0.01). Gatifloxacin resistance in Staphylococcus rose from pre-COVID-19 (15.2%) to COVID-19 (32.7%), remaining high post-COVID-19 (29.7%). A similar trend was observed in Streptococcus and Corynebacterium, where resistance rose sharply from 12.0% and 22.2% pre-COVID-19 to 42.9% during COVID-19, and remained elevated at 40.0% and 46.4% post-COVID-19, respectively (p < 0.01). These findings emphasize the rapid rise of fluoroquinolone resistance in several bacterial groups, underscoring the urgent need for continuous surveillance and improved antimicrobial stewardship to enhance treatment outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China; (Q.S.); (D.M.); (Z.Z.); (A.I.Q.); (M.W.); (Z.C.); (Y.Z.); (Z.W.); (K.C.); (X.X.); (X.L.)
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14
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Nguyen THN, Nguyen HQ, Le NTT, Nguyen HTN, Dinh HC, Nguyen TN, Nguyen HM. Trends of Colistin MIC Among Acinetobacter Baumannii and Pseudomonas aeruginosa at a First-Class Hospital in Vietnam. J Trop Med 2025; 2025:6165665. [PMID: 40124533 PMCID: PMC11930383 DOI: 10.1155/jotm/6165665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 02/21/2025] [Indexed: 03/25/2025] Open
Abstract
Introduction: A. baumannii and P. aeruginosa belong to the multidrug-resistant Gram-negative bacteria group, posing significant challenges in treatment. Colistin is considered the last-line antibiotic for treating this bacterium. It is essential to determine the minimum inhibitory concentration (MIC) to adjust the appropriate dosage. Method: A cross-sectional descriptive study using data from January 2020 to December 2024 was conducted. Results: The infections caused by A. baumannii and P. aeruginosa showed an increasing trend over the years, accounting for 17.4% and 9.6% of common multidrug-resistant Gram-negative bacteria, respectively. A. baumannii exhibited higher resistance rates than P. aeruginosa with multiple tested antibiotics. Although no Colistin-resistant strains were observed for either bacterium of interest during the observation period, both bacteria of interest showed a statistically significant change during the survey period (p < 0.05). In addition, the MIC value of ≤ 0.75 μg/mL was the most prevalent over 80% from 2020 to 2021, but its percentage declined strongly by 60%-65% in the next 3 years (p < 0.0001). Meanwhile, the MIC value of 1.0 μg/mL became the most common over 70% with a statistically significant difference (p < 0.0001). Regarding the MIC value based on infection types, the MIC value for P. aeruginosa causing septicemia was considerably concentrated at 1.0 μg/mL at 84.6%, while its percentage was lower in A. baumannii at 37.9% (p < 0.0001). Looking into MIC values based on carbapenem-resistant proportions, the MIC values from 1.0 to 2.0 μg/mL were higher in imipenem-resistant strains of both bacteria of interest compared with nonresistant strains (p < 0.0001). This difference was also observed in meropenem-resistant A. baumannii but was not demonstrated in P. aeruginosa. Conclusions: Although no colistin-resistant strains were observed, A. baumannii and P. aeruginosa showed statistically significant changes in the most prevalent colistin MIC values, which have been approaching the resistance threshold over the years. It is essential to implement control measures of colistin usage before bacteria become completely resistant.
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Affiliation(s)
- Tuan Huu Ngoc Nguyen
- Biomedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Huy Quang Nguyen
- Biomedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ngan Thi Thu Le
- Biomedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Han To Ngoc Nguyen
- Laboratory Department, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Hung Cao Dinh
- Department of Internal Medicine, Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Department of Internal Medicine, Faculty of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tam Ngoc Nguyen
- Laboratory Department, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Ha Minh Nguyen
- Biomedical Research Center, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Laboratory Department, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
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15
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Ma ESK, Hsu E, Chow V, Chow T, Kung KH, Au A, Chen H. Rebound of Antibiotic Use and Respiratory Infections After Resumption of Normalcy From COVID-19 in Hong Kong. Infect Drug Resist 2025; 18:1325-1337. [PMID: 40092846 PMCID: PMC11910044 DOI: 10.2147/idr.s502126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Accepted: 02/04/2025] [Indexed: 03/19/2025] Open
Abstract
Purpose During COVID-19 pandemic, use of antimicrobial has been shown to be reduced coupled with various respiratory infections. We investigated whether this effect on reduction of antibiotic prescription can be sustained after resumption of normalcy and lifting of public health measures. Methods We compared the wholesale supply of antimicrobials using mean annual Daily Defined Dose/1000 inhabitants (DID) in different sectors in pre-COVID-19 (2014-2019), COVID-19 (2020-2022) and post-COVID-19 (2023) periods. We grouped the data according to AWaRe categorisation namely Access, Watch and Reserve defined by WHO, and analysed the trends of the top 10 antibiotics and broad-spectrum antimicrobials. The trends in statutory notifiable diseases including scarlet fever, pneumococcal infections, chickenpox, tuberculosis, and pertussis and influenza-like-illness detected by sentinel surveillance system was analysed by negative-binominal regression. Results Compared to baseline level, an overall reduction of 27.2% of antimicrobial utilization was observed during the pandemic years, with a rebound recorded in 2023, up to 89.5% of the pre-pandemic level. The access group of antimicrobials accounted for 57.9% in 2014 gradually increased to 60.2% in 2023 across the pandemic years. Concurrently, reduction in incidence of scarlet fever, pneumococcal infections, chickenpox, tuberculosis, pertussis and influenza-like-illness was observed during COVID-19 pandemic with statistical decreasing trend, p<0.05 for scarlet fever, pneumococcal infections and chickenpox. Rebound in all these infections was reported in 2023, except for chickenpox which showed continued decrease in incidence. Conclusion We demonstrated a substantial reduction of antibiotic use during the COVID-19 pandemic, which rebounded in 2023, likely due to increased incidence of respiratory diseases after lifting of public health and social measures. We urged for close monitoring of the antimicrobial resistance pattern of different bacteria due to the inter-connectiveness and global impact of these two pandemics.
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Affiliation(s)
- Edmond Siu-Keung Ma
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
| | - Enoch Hsu
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
| | - Vincent Chow
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
| | - Tracy Chow
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
| | - K H Kung
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
| | - Albert Au
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
| | - Hong Chen
- Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, Special Administrative Region, People's Republic of China
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16
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de Almeida LKS, Silva LC, Guidone GHM, de Oliva BHD, do Nascimento AB, Faustino G, da Silva Pimenta J, Vespero EC, Rocha SPD. Impact of COVID-19 pandemic on antimicrobial resistance of Proteus mirabilis in a Brazilian hospital. Braz J Microbiol 2025; 56:499-510. [PMID: 39630218 PMCID: PMC11885744 DOI: 10.1007/s42770-024-01568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 11/07/2024] [Indexed: 03/09/2025] Open
Abstract
This study analyzes the resistance and virulence profiles of Proteus mirabilis isolates obtained from patients admitted to the University Hospital of Londrina, Paraná, between 2019 and 2022. We evaluated the antimicrobial resistance phenotypes, genes associated with resistance, biofilm formation through a phenotypic assay, and the presence of specific virulence genes. When comparing the "pre-pandemic" (2019) and "pandemic" (2020-2022) periods, we observed an increase in resistance rates to all tested antimicrobials. Multidrug-resistant (MDR) pathogens producing extended-spectrum β-lactamase (ESBL) phenotypes were isolated in both periods, but their occurrence was significantly higher during the pandemic. We also observed an increase in the frequency of nearly all studied resistance genes. The virulence profiles remained largely unchanged. Analysis of patients' clinical and demographic data revealed that those hospitalized during the pandemic were older, required longer hospital stays, and had a higher usage of invasive devices. These findings suggest that the recent COVID-19 pandemic has impacted the antimicrobial resistance of P. mirabilis, a bacterium of significant clinical interest associated with urinary tract infections (UTIs) and healthcare-associated infections (HAIs).
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Affiliation(s)
- Luana Karolyne Salomão de Almeida
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil
| | - Luana Carvalho Silva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil
| | - Gustavo Henrique Migliorini Guidone
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil
| | - Bruno Henrique Dias de Oliva
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil
| | - Arthur Bossi do Nascimento
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil
| | - Gabriela Faustino
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil
| | - Julia da Silva Pimenta
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, University Hospital of Londrina, State University of Londrina, Londrina, Paraná, Brazil
| | - Eliana Carolina Vespero
- Department of Pathology, Clinical and Toxicological Analysis, Health Sciences Center, University Hospital of Londrina, State University of Londrina, Londrina, Paraná, Brazil
| | - Sergio Paulo Dejato Rocha
- Laboratory of Bacteriology, Department of Microbiology, Center of Biological Sciences, State University of Londrina, Rodovia Celso Garcia Cid, PO-BOX 6001, Londrina, 86051-980, Paraná, Brazil.
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Wang Z, Cheng H, Chen R, Wang MX, Jiang N, Lu Z, Yang H. Omnipotent antibacterial cotton fabrics with superhydrophobic and photothermal properties. Int J Biol Macromol 2025; 290:138901. [PMID: 39706440 DOI: 10.1016/j.ijbiomac.2024.138901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 11/29/2024] [Accepted: 12/16/2024] [Indexed: 12/23/2024]
Abstract
Due to the outbreak of global public health emergency, antibacterial fabrics such as face masks are in great demand. However, common antibacterial fabrics cannot kill bacteria in minutes and they are easy to be contaminated and lost biological activity. In this work, omnipotent antibacterial cotton fabrics with superhydrophobic and photothermal properties are developed by the combination of dopamine with copper sulfide (CuS) and silver nanoparticles on cotton fabrics, and post-modification with PDMS. The prepared PDA/CuS/Ag/PDMS composite fabrics were characterized by FE-SEM, XRD, EDS, ATR-FTIR and water contact angle. The photothermal antimicrobial properties of the fabrics were evaluated with Staphylococcus aureus (S. aureus) and Escherichia coli (E. coil) under near-infrared light (NIR) illumination or not. The results showed that the obtained superhydrophobic PDA/CuS/Ag/PDMS composite fabrics had excellent water repellence and self-cleaning effect. Regardless of NIR irradiation or not, PDA/CuS/Ag/PDMS composite fabrics possessed high antibacterial activity against S. aureus and E. coil, which proves their omnipotent antibacterial property.
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Affiliation(s)
- Zitong Wang
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Environmental Ecology and Biological Engineering, Wuhan Institute of Technology, Wuhan 430205, PR China; State Key Laboratory of New Textile Materials and Advanced Processing Technologies, Wuhan Textile University, Wuhan 430200, PR China
| | - Huajing Cheng
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Environmental Ecology and Biological Engineering, Wuhan Institute of Technology, Wuhan 430205, PR China
| | - Rong Chen
- State Key Laboratory of New Textile Materials and Advanced Processing Technologies, Wuhan Textile University, Wuhan 430200, PR China.
| | - Ming-Xi Wang
- School of Chemical and Environmental Engineering, Wuhan Institute of Technology, Wuhan 430205, PR China
| | - Nan Jiang
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Environmental Ecology and Biological Engineering, Wuhan Institute of Technology, Wuhan 430205, PR China
| | - Zhong Lu
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Environmental Ecology and Biological Engineering, Wuhan Institute of Technology, Wuhan 430205, PR China
| | - Hao Yang
- Key Laboratory for Green Chemical Process of Ministry of Education, School of Environmental Ecology and Biological Engineering, Wuhan Institute of Technology, Wuhan 430205, PR China.
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Dou MH, Huang JY, Li PY, Chen WL, Wang XR, Yang TZ, Fan XY, Zhang XY, Lu Y, Bai J, Du SY. How can traditional Chinese medicine enhance the efficacy of antibiotics in the treatment of MRSA-infected pneumonia: An experimental study on the combination of Reyanning mixture (RYN) and linezolid. JOURNAL OF ETHNOPHARMACOLOGY 2025; 340:119221. [PMID: 39653103 DOI: 10.1016/j.jep.2024.119221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 12/02/2024] [Accepted: 12/05/2024] [Indexed: 12/19/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Reyanning Mixture (RYN) is a Chinese patent medicine widely used in the treatment of respiratory inflammatory diseases in China and has potential in the treatment of bacteria-infected pneumonia. AIM OF THE STUDY The present study aimed to demonstrate the therapeutic potential of RYN in combination with linezolid for the treatment of MRSA-infected pneumonia and to explore the mechanisms of action and active components. MATERIALS AND METHODS The pharmacodynamics of RYN alone and in combination with linezolid was investigated in a rat model of MRSA-induced pneumonia. Transcriptomics, ELISA, Western blot and qRT-PCR were used to explore and verify the pharmacological mechanism of the anti-inflammatory effect of RYN. UPLC-MS and molecular docking were used to explore the anti-inflammatory components of RYN for the treatment of MRSA-infected pneumonia. RESULTS In vivo, RYN reduced lung injury and inflammation in rats with pneumonia. In particular, the combination of RYN and linezolid enhanced the therapeutic effect compared to that of either treatment alone. Further research suggests that the synergistic therapeutic effect of the combination may be related to the inhibition of the inflammatory response by RYN and the enhancement of linezolid inhibition and clearance of MRSA in lung tissues by RYN. RYN plays an anti-inflammatory role in MRSA-infected pneumonia by inhibiting the TLR2/NF-κB/NLRP3 pathway, with 7 active components that may play a dominant role. CONCLUSIONS These results indicate that RYN may serve as an adjuvant drug to antibiotics for the treatment of MRSA-associated pneumonia. Exploration of its mechanisms and active components is conducive to the clinical application and quality improvement of RYN. More importantly, this study showed that the synergistic therapeutic effect of the combination of traditional Chinese medicine and antibiotics may be a valuable therapeutic strategy.
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MESH Headings
- Animals
- Linezolid/pharmacology
- Linezolid/administration & dosage
- Linezolid/therapeutic use
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Methicillin-Resistant Staphylococcus aureus/drug effects
- Male
- Rats, Sprague-Dawley
- Rats
- Drugs, Chinese Herbal/pharmacology
- Drugs, Chinese Herbal/administration & dosage
- Drugs, Chinese Herbal/therapeutic use
- Drug Therapy, Combination
- Medicine, Chinese Traditional/methods
- Drug Synergism
- Staphylococcal Infections/drug therapy
- Pneumonia, Staphylococcal/drug therapy
- Pneumonia, Staphylococcal/microbiology
- Lung/drug effects
- Lung/pathology
- Lung/microbiology
- Anti-Inflammatory Agents/pharmacology
- NLR Family, Pyrin Domain-Containing 3 Protein/metabolism
- Disease Models, Animal
- Molecular Docking Simulation
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Affiliation(s)
- Min-Hang Dou
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jia-Yi Huang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Peng-Yue Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Wan-Ling Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xin-Ran Wang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Tian-Zi Yang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xiao-Yu Fan
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xin-Yu Zhang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yang Lu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jie Bai
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Shou-Ying Du
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 100029, China.
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Tsujimoto H, Fujikura Y, Hamamoto TA, Horiguchi H, Takahata R, Ishibashi Y, Sugihara T, Kouzu K, Itazaki Y, Fujishima SI, Okamoto K, Kajiwara Y, Matsukuma S, Ueno H. Drug resistance of Pseudomonas aeruginosa based on the isolation sites and types of gastrointestinal diseases: An observational study. Fukushima J Med Sci 2025; 71:25-34. [PMID: 39694500 PMCID: PMC11799663 DOI: 10.5387/fms.24-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/25/2024] [Indexed: 12/20/2024] Open
Abstract
INTRODUCTION We investigated the drug resistance status of Pseudomonas aeruginosa (P. aeruginosa) focusing on its isolation sites and types of diseases. Materials and methods: A microbiological laboratory database was searched to identify all clinical cultures positive for P. aeruginosa. Clinicopathologic features and susceptibility of P. aeruginosa to any antibiotics were evaluated in patients admitted to the division of upper (Upper-GI group) or lower gastrointestinal surgery (Lower-GI group). In addition, we investigated the susceptibility of P. aeruginosa to any antibiotics based on the isolation site. Results:P. aeruginosa was frequently detected in the sputum and urine of the Upper-GI and Lower-GI groups, respectively. Among P. aeruginosa isolates from drain discharge, a significantly higher rate of resistance to imipenem, amikacin, and ciprofloxacin was observed; among P. aeruginosa isolates from wounds, a substantially higher proportion had resistance to imipenem and cefozopran in the Upper-GI group. However, there was no difference between the two groups in the drug resistance of P. aeruginosa isolated from urine, sputum, blood, and ascites. P. aeruginosa isolated from sputum showed more resistance to imipenem and ciprofloxacin than those isolated from other sites. Conclusion: There were significant differences in the drug resistance of P. aeruginosa based on the isolation sites and types of diseases. .
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Affiliation(s)
- Hironori Tsujimoto
- Department of Surgery, National Defense Medical College
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, National Defense Medical College
| | - Yuji Fujikura
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, National Defense Medical College
| | - Taka-aki Hamamoto
- Department of Laboratory Medicine, National Defense Medical College Hospital
| | | | - Risa Takahata
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, National Defense Medical College
| | | | | | - Keita Kouzu
- Department of Surgery, National Defense Medical College
| | | | | | | | | | - Susumu Matsukuma
- Department of Laboratory Medicine, National Defense Medical College Hospital
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College
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Kim T, Moehring RW, Turner NA, Ashley ED, Crane L, Padgette P, Payne VC, Roach L, Wood B, Anderson DJ. Long-term trends in the incidence of hospital-acquired carbapenem-resistant Enterobacterales and antimicrobial utilization in a network of community hospitals in the Southeastern United States from 2013 to 2023. Infect Control Hosp Epidemiol 2024; 46:1-7. [PMID: 39624024 PMCID: PMC11717479 DOI: 10.1017/ice.2024.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 09/04/2024] [Accepted: 09/11/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed. METHODS We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros. RESULTS 126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57-0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89-0.99]; p = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06-1.66]; p = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman's coefficient = 0.176; p < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID. CONCLUSIONS The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.
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Affiliation(s)
- Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Rebekah W. Moehring
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Antimicrobial Stewardship Outreach Network, Durham, NC, USA
| | - Nicholas A. Turner
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Elizabeth Dodds Ashley
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Antimicrobial Stewardship Outreach Network, Durham, NC, USA
| | - Linda Crane
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Polly Padgette
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Valerie C. Payne
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Linda Roach
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Brittain Wood
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
- Duke Antimicrobial Stewardship Outreach Network, Durham, NC, USA
- Duke Infection Control Outreach Network, Durham, NC, USA
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Kibria MK, Ali MA, Mollah MNH. Exploring bacterial key genes and therapeutic agents for breast cancer among the Ghanaian female population: Insights from In Silico analyses. PLoS One 2024; 19:e0312493. [PMID: 39585882 PMCID: PMC11588272 DOI: 10.1371/journal.pone.0312493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 10/07/2024] [Indexed: 11/27/2024] Open
Abstract
Breast cancer (BC) is yet a significant global health challenge across various populations including Ghana, though several studies on host-genome associated with BC have been investigated molecular mechanisms of BC development and progression, and candidate therapeutic agents. However, a little attention has been given on microbial genome in this regard, although alterations in microbiota and epigenetic modifications are recognized as substantial risk factors for BC. This study focused on identifying bacterial key genes (bKGs) associated with BC infections in the Ghanaian population and exploring potential drug molecules by targeting these bKGs through in silico analyses. At first, 16S rRNA bacterial sequence data were downloaded from NCBI database comprising 520 samples from BC patients and 442 from healthy controls. Analysis of 16S rRNA-Seq data showed significant differences in bacterial abundance between BC and healthy groups and identified 26 differential genera with the threshold values at |log2FC|>2.0 and p-value≤0.05. It was observed that two genera Prevotella and Anaerovibria are significantly upregulated in BC patients and others are downregulated. Functional analysis based on all differential genera identified 19 MetaCyc signaling pathways, twelve of which were significantly enriched in BC patients by containing 165 genes Top-ranked 10 genes mdh, pykF, gapA, zwf, pgi, tpiA, pgk, pfkA, ppsA, and pykA were identified as BC-causing bacterial key genes (bKGs) through protein-protein interaction network analysis. Subsequently, the bKG-guided top ranked 10 drug molecules Digitoxin, Digoxin, Ledipasvir, Suramin, Ergotamine, Venetoclax, Nilotinib, Conivaptan, Dihydroergotamine, and Elbasvir were identified using molecular docking analysis. The stability of top-ranked three drug-target complexes (Digitoxin-pykA, Digoxin-mdh, and Ledipasvir-pgi) were confirmed through the molecular dynamics simulation studies. Therefore, these findings might be useful resources to the wet-lab researchers for further experimental validation on bacterial therapies against BC.
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Affiliation(s)
- Md. Kaderi Kibria
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- Department of Statistics, Hajee Mohammad Danesh Science and Technology University, Dinajpur, Bangladesh
| | - Md. Ahad Ali
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- Department of Chemistry, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Nurul Haque Mollah
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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22
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Jeverica S, Maganja DB, Dernič J, Golob P, Stepišnik A, Novak B, Papst L, Dodič AJ, Gasparini M. The Influence of COVID-19 on Antimicrobial Resistance Trends at a Secondary Care Hospital in Slovenia: An Interrupted Time Series Analysis. Antibiotics (Basel) 2024; 13:1033. [PMID: 39596728 PMCID: PMC11590949 DOI: 10.3390/antibiotics13111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/27/2024] [Accepted: 10/31/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives. Our study aimed to determine the development of antibiotic resistance during the peri-pandemic period in a regional secondary care hospital using an interrupted time series analysis. Methods. We analyzed data from seven years, accounting for 441,149 patient days. The incidence density of multidrug-resistant bacteria (MDR) burden and infection was reported per 1000 patient days. Results. During the COVID-19 period, a significant increase in the mean incidence density of the total MDR burden from 4.93 to 5.81 per 1000 patient days was observed (p = 0.007). On the other hand, the mean incidence density of MDR infections decreased from 1.61 to 1.29 per 1000 patient days (p = 0.019). Using the interrupted time series analysis, the same trends were observed, namely the overall increasing trend in MDR burden and the overall decreasing trend in MDR infections. This divergent trend is mainly due to similar trends in several Gram-negative MDR, namely ESBL-EC, ESBL-KP and CRE. Conclusions. Due to the increasing burden of MDR, it is necessary to strengthen AMR surveillance. In addition, strict infection prevention and control measures, and antimicrobial stewardship programs continue to be important components in the fight against resistant bacteria.
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Affiliation(s)
- Samo Jeverica
- Izola General Hospital, 6310 Izola, Slovenia; (J.D.); (P.G.); (A.S.); (B.N.); (M.G.)
| | | | - Jani Dernič
- Izola General Hospital, 6310 Izola, Slovenia; (J.D.); (P.G.); (A.S.); (B.N.); (M.G.)
| | - Peter Golob
- Izola General Hospital, 6310 Izola, Slovenia; (J.D.); (P.G.); (A.S.); (B.N.); (M.G.)
| | - Alenka Stepišnik
- Izola General Hospital, 6310 Izola, Slovenia; (J.D.); (P.G.); (A.S.); (B.N.); (M.G.)
| | - Bojan Novak
- Izola General Hospital, 6310 Izola, Slovenia; (J.D.); (P.G.); (A.S.); (B.N.); (M.G.)
| | - Lea Papst
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia;
| | - Anamarija Juriševič Dodič
- Department of Medical Microbiology Koper, National Laboratory of Health, Environment and Food, 2000 Maribor, Slovenia;
| | - Mladen Gasparini
- Izola General Hospital, 6310 Izola, Slovenia; (J.D.); (P.G.); (A.S.); (B.N.); (M.G.)
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23
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Wang Y, Zhang Y, Wang Q, Li W, Shi D, Xu Y. The Impact of Infection Control Policies on Hospital Acquired Infections by MDROs from 2016 to 2023. Infect Drug Resist 2024; 17:4213-4221. [PMID: 39359495 PMCID: PMC11446211 DOI: 10.2147/idr.s481412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/17/2024] [Indexed: 10/04/2024] Open
Abstract
Purpose Hospital-acquired infections (HAIs) caused by multidrug-resistant organisms (MDROs) pose a significant challenge to healthcare systems. The present study aimed to evaluate the impact of the infection policy to COVID-19 on the incidence of HAIs caused by MDROs. Methods We conducted an eight-years retrospective analysis at a hospital in Shanghai, China. Bloodstream, sputum, and urinary tract cultures of MDROs obtained 48h after admission were collected monthly from January 2016 to Dec 2023. Occupied bed days (OBDs) were used to generate monthly HAI incidences per 10,000 OBDs. The study period was divided into pre-control, in-control, and post-control cohorts, in January 2020 and January 2022. The incidence was compared using interrupted time-series regression. Results In total, 6763 MDRO cultures were identified, comprising 1058 bloodstream, 4581 sputum, and 1124 urine cultures derived from 4549 patients. The incidence rates of all HAIs were 8.68 per 10,000 OBDs in the pre-control cohort, 9.76 per 10,000 OBDs in the in-control cohort and 12.58 per 10,000 OBDs in the post-control cohorts, respectively. A downward trend in the incidence of HAI was observed in the post-control cohort (p<0.05). Conclusion This study demonstrates that while the COVID-19 pandemic poses a significant challenge to infection control within hospitals, it provides a unique opportunity to enhance infection control measures and evaluate their effectiveness. In addition, these findings highlight the need for more targeted prevention and control strategies against different pathogens in future epidemics.
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Affiliation(s)
- Yichen Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yibo Zhang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Qun Wang
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Wenhui Li
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Dake Shi
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yumin Xu
- Department of Hospital Infection Management, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
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24
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Kern WV, Steib-Bauert M, Baumann J, Kramme E, Först G, de With K. Impact of the COVID-19 Pandemic on Inpatient Antibiotic and Antifungal Drug Prescribing Volumes in Germany. Antibiotics (Basel) 2024; 13:837. [PMID: 39335010 PMCID: PMC11429143 DOI: 10.3390/antibiotics13090837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/27/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Previous studies found that the coronavirus disease 2019 (COVID-19) pandemic had a variable impact on the consumption of antimicrobial drugs in human medicine, with trends in several European countries differing between community and inpatient prescribing. AIM This study analysed changes in the volumes and use density of antibacterial and antifungal drugs dispensed in acute care hospitals in Germany between 2019 and 2022. METHODS Surveillance data for the four years available from 279 hospitals were expressed as the total volumes of daily doses or as use density (daily doses per 100 patient/occupied bed days) per year and analysed descriptively, using recommended hospital-adapted daily dose definitions (RDDs) and (as sensitivity analysis) WHO/ATC-defined daily dose definitions (DDD). Hospitals were stratified according to size (number of beds), university affiliation, and location (East, West, South). RESULTS There were significant decreases in both the total number of patient days and antibacterial drug volumes in 2020 through 2022 compared with 2019. The relative changes between 2019 and 2020, 2021, and 2022 were -12.8%, -13.5%, and -13.3% for patient days, and -9.7%, -11.0%, and -10.1% for antibacterial RDDs, respectively. Broad-spectrum betalactams, notably piperacillin-tazobactam and carbapenems, increased in volume, unlike most other drug classes. The resulting antibacterial drug use density was slightly but significantly increased, with pooled means (and medians) of 43.3 (40.0) RDD/100 in 2019 compared to 44.8 (41.7), 44.5 (40.80), and 44.9 (41.7) RDD/100 in the years 2020 through 2022, respectively. Antifungal drug volumes and use density increased after 2019 and peaked in 2021 (the difference between 2019 and 2021 for total volumes was +6.4%, and that for pooled mean use density values was +22.9%, respectively). These trends were similar in the different hospital strata and comparable when DDDs instead of RDDs were used. CONCLUSIONS Similar to what has been observed in a majority of European countries, the total volume of antibacterial drug use in German acute care hospitals decreased with the pandemic, without a rebound phenomenon in 2022. In association with restricted hospital capacities and presumably more immunocompromised general medicine patients, however, inpatient prescribing of (primarily broad-spectrum) antibacterials and of antifungal drugs increased.
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Affiliation(s)
- Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre, and Faculty of Medicine, Albert-Ludwigs-University, 79106 Freiburg, Germany
- Akademie für Infektionsmedizin, 10789 Berlin, Germany
| | - Michaela Steib-Bauert
- Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre, and Faculty of Medicine, Albert-Ludwigs-University, 79106 Freiburg, Germany
| | - Jürgen Baumann
- Central Pharmacy, Medius-Kliniken, 73760 Ostfildern-Ruit, Germany
- ADKA-Bundesverband Deutscher Krankenhausapotheker, 10559 Berlin, Germany
| | - Evelyn Kramme
- Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein Campus Lübeck, University of Lübeck, 23562 Lübeck, Germany
- DGI-Deutsche Gesellschaft für Infektiologie, 10789 Berlin, Germany
| | - Gesche Först
- Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Centre, and Faculty of Medicine, Albert-Ludwigs-University, 79106 Freiburg, Germany
- ADKA-Bundesverband Deutscher Krankenhausapotheker, 10559 Berlin, Germany
- Institute of Pharmaceutical Sciences, Faculty of Chemistry and Pharmacy, Albert-Ludwigs-University, 79085 Freiburg, Germany
| | - Katja de With
- DGI-Deutsche Gesellschaft für Infektiologie, 10789 Berlin, Germany
- Institute of Infectious Diseases, University Hospital Carl Gustav Carus, Technical University, 01307 Dresden, Germany
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25
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Reffat N, Schwei RJ, Griffin M, Pop-Vicas A, Schulz LT, Pulia MS. A scoping review of bacterial resistance among inpatients amidst the COVID-19 pandemic. J Glob Antimicrob Resist 2024; 38:49-65. [PMID: 38789083 PMCID: PMC11392638 DOI: 10.1016/j.jgar.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic disrupted antimicrobial stewardship and infection prevention operations worldwide, raising concerns for an acceleration of antimicrobial resistance (AMR). Therefore, we aimed to define the scope of peer reviewed research comparing AMR in inpatient bacterial clinical cultures before and after the start of the COVID-19 pandemic. METHODS We conducted a scoping review and searched PubMed, Scopus, and Web of Science through 15 June 2023. Our inclusion criteria were: (1) English language, (2) primary evidence, (3) peer-reviewed, (4) clinical culture data from humans, (5) AMR data for at least one bacterial order/species, (6) inpatient setting, (7) use of statistical testing to evaluate AMR data before and during the COVID-19 pandemic. Reviewers extracted country, study design, type of analysis, study period, setting and population, number of positive cultures or isolates, culture type(s), method of AMR analysis, organisms, and AMR results. Study results were organised by organism and antibiotic class or resistance mechanism. AMR results are also summarised by individual study and across all studies. RESULTS In total, 4805 articles were identified with 55 papers meeting inclusion criteria. Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus were the most commonly studied organisms. There were 464 bacterial AMR results across all studies with 82 (18%) increase, 71 (15%) decrease, and 311 (67%) no change results. CONCLUSIONS The literature examining the impact of COVID-19 on AMR among inpatients is diverse with most results reflecting no change pre/post pandemic. Ongoing inquiry is needed into evolving patterns in AMR post COVID-19.
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Affiliation(s)
- Noora Reffat
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Meggie Griffin
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Aurora Pop-Vicas
- Department of Medicine-Division of Infectious Disease, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucas T Schulz
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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Duan Y, Ren J, Wang J, Wang S, Zhang R, Zhang H, Hu J, Deng W, Li W, Chen B. The Impact of Early Antibiotic Use on Clinical Outcomes of Patients Hospitalized with COVID-19: A Propensity Score-Matched Analysis. Infect Drug Resist 2024; 17:3425-3438. [PMID: 39145118 PMCID: PMC11322505 DOI: 10.2147/idr.s470957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
Purpose Early empiric antibiotics were prescribed to numerous patients during the Coronavirus disease 2019 (COVID-19) pandemic. However, the potential impact of empiric antibiotic therapy on the clinical outcomes of patients hospitalized with COVID-19 is yet unknown. Methods In this retrospective cohort study, early antibiotics use cohort was defined as control group, which was compared with no antibiotic use and delayed antibiotic use cohorts for all-cause mortality during hospitalization. The 1:2 propensity score matched patient populations were further developed to adjust confounding factors. Survival curves were compared between different cohorts using a Log rank test to assess the early antibiotic effectiveness. Results We included a total of 1472 COVID-19 hospitalized patients, of whom 87.4% (1287 patients) received early antibiotic prescriptions. In propensity-score-matched datasets, our analysis comprised 139 patients with non-antibiotic use (with 278 matched controls) and 27 patients with deferred-antibiotic use (with 54 matched controls). Patients with older ages, multiple comorbidities, severe and critical COVID-19 subtypes, higher serum infection indicators, and inflammatory indicators at admission were more likely to receive early antibiotic prescriptions. After adjusting confounding factors likely to influence the prognosis, there is no significant difference in all-cause mortality (HR=1.000(0.246-4.060), p = 1.000) and ICU admission (HR=0.436(0.093-2.04), p = 0.293), need for mechanical ventilation (HR=0.723(0.296-1.763), p = 0.476) and tracheal intubation (HR=1.338(0.221-8.103), p = 0.751) were observed between early antibiotics use cohort and non-antibiotic use cohort. Conclusion Early antibiotics were frequently prescribed to patients in more severe disease condition at admission. However, early antibiotic treatment failed to demonstrate better clinical outcomes in hospitalized patients with COVID-19 in the propensity-score-matched cohorts.
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Affiliation(s)
- Yishan Duan
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Jing Ren
- The Integrated Care Management Center, West China Hospital of Sichuan University, Chengdu, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Jing Wang
- Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Suyan Wang
- Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Rui Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Huohuo Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Jinrui Hu
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Wen Deng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
- Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
- Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
| | - Bojiang Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
- Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People’s Republic of China
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Damonti L, Gasser M, Kronenberg A, Buetti N. Epidemiology of bloodstream infections caused by extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae in Switzerland, 2015-2022: secular trends and association with the COVID-19 pandemic. J Hosp Infect 2024; 150:145-152. [PMID: 38838742 DOI: 10.1016/j.jhin.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The association between the COVID-19 pandemic and the incidence of invasive infections caused by multidrug-resistant organisms remains a topic of debate. AIM To analyse the national incidence rates of bloodstream infections (BSI) caused by Escherichia coli (EC) and Klebsiella pneumoniae (KP) with extended-spectrum cephalosporin resistance (ESCR) in two distinct regions in Switzerland, each exhibiting varying antimicrobial resistance patterns and that were impacted differently by the pandemic. METHODS Data was analysed from positive blood cultures prospectively collected by the nationwide surveillance system (ANRESIS) from January 1st, 2015, to August 31st, 2022. To explore the potential relationship between COVID-19 patient occupancy and ESCR incidence rates, an in-depth analysis was conducted over the two-year pandemic period from April 1st, 2020, to March 30th, 2022, using Quasi-Poisson and logistic regression analyses. FINDINGS During the study period, 40,997 EC-BSI and 8537 KP-BSI episodes were collected and reported to ANRESIS by the participating hospitals. ESCR was observed in 11% (N = 4313) of E. coli and 8% (N = 664) of K. pneumoniae, respectively. A significant reduction in ESCR-EC BSI incidence occurred during the pandemic in the region with the highest COVID-19 incidence. Conversely, ESCR-KP BSI incidence initially fell considerably and then increased during the pandemic in both regions, though this effect was not statistically significant. No association between hospital occupancy from COVID-19 patients and these trends was observed. CONCLUSION In the early phase of the COVID-19 pandemic, a decrease in ESCR rates was observed, particularly in ESCR-EC BSI within the most heavily impacted region.
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Affiliation(s)
- L Damonti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - M Gasser
- Swiss Centre for Antibiotic Resistance, Institute for Infectious Diseases, University Bern, Bern, Switzerland
| | - A Kronenberg
- Swiss Centre for Antibiotic Resistance, Institute for Infectious Diseases, University Bern, Bern, Switzerland
| | - N Buetti
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland; Université Paris - Cité, INSERM, IAME UMR 1137, Paris, France
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Ai L, Fang L, Zhou C, Liu B, Yang Q, Gong F. The impact of the COVID-19 pandemic on Staphylococcus aureus infections in pediatric patients admitted with community acquired pneumonia. Sci Rep 2024; 14:15737. [PMID: 38977804 PMCID: PMC11231152 DOI: 10.1038/s41598-024-66071-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
The COVID-19 pandemic has significantly transformed the infection spectrum of various pathogens. This study aimed to evaluate the impact of the COVID-19 pandemic on Staphylococcus aureus (S. aureus) infections among pediatric patients with community acquired pneumonia (CAP). We retrospectively reviewed pediatric CAP admissions before (from 2018 to 2019) and during (from 2020 to 2022) the COVID-19 pandemic. The epidemiology and antimicrobial resistance (AMR) profiles of S. aureus isolates were examined to assess the pandemic's effect. As a result, a total of 399 pediatric CAP patients with S. aureus infections were included. The positivity rate, gender, and age distribution of patients were similar across both periods. There was a marked reduction in respiratory co-infections with Haemophilus influenzae (H. influenzae) during the COVID-19 pandemic, compared to 2019. Additionally, there were significant changes in the resistance profiles of S. aureus isolates to various antibiotics. Resistance to oxacillin and tetracycline increased, whereas resistance to penicillin, gentamicin, and quinolones decreased. Notably, resistance to erythromycin significantly decreased in methicillin-resistant S. aureus (MRSA) strains. The number of S. aureus isolates, the proportion of viral co-infections, and the number of resistant strains typically peaked seasonally, primarily in the first or fourth quarters of 2018, 2019, and 2021. However, shifts in these patterns were noted in the first quarter of 2020 and the fourth quarter of 2022. These findings reveal that the COVID-19 pandemic has significantly altered the infection dynamics of S. aureus among pediatric CAP patients, as evidenced by changes in respiratory co-infections, AMR patterns, and seasonal trends.
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Affiliation(s)
- Ling Ai
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Street, Chongqing, 402160, China
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Liang Fang
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Chanjuan Zhou
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Beizhong Liu
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
- Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education,, Department of Laboratory Medicine, Chongqing Medical University, Chongqing, 400016, China
| | - Quan Yang
- Department of Radiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China
| | - Fang Gong
- Department of General Practice, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Street, Chongqing, 402160, China.
- Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing, 402160, China.
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Ilmavirta H, Ollgren J, Räisänen K, Kinnunen T, Hakanen AJ, Rantakokko-Jalava K, Jalava J, Lyytikäinen O. Impact of the COVID-19 pandemic on extended-spectrum β-lactamase producing Escherichia coli in urinary tract and blood stream infections: results from a nationwide surveillance network, Finland, 2018 to 2022. Antimicrob Resist Infect Control 2024; 13:72. [PMID: 38971782 PMCID: PMC11227720 DOI: 10.1186/s13756-024-01427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum β-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen. METHODS Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex. RESULTS The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years. CONCLUSIONS The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.
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Affiliation(s)
- Heikki Ilmavirta
- Department of Clinical Microbiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- ISLAB Laboratory Centre, Kuopio, Finland.
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Kati Räisänen
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tuure Kinnunen
- Department of Clinical Microbiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- ISLAB Laboratory Centre, Kuopio, Finland
| | - Antti Juhani Hakanen
- Tyks Laboratories, Turku University Hospital (TYKS) and University of Turku (UTU), Turku, Finland
| | - Kaisu Rantakokko-Jalava
- Tyks Laboratories, Turku University Hospital (TYKS) and University of Turku (UTU), Turku, Finland
| | - Jari Jalava
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Lo Moro G, Marengo N, Mara A, Paño Pardo JR, Hernandez S, Fusté E, Pujol M, Zotti CM, Limón E, Vicentini C. Antimicrobial stewardship programs in acute-care hospitals: A multicenter assessment of structure, process, and outcome indicators in Italy and Spain. J Infect Public Health 2024; 17:102457. [PMID: 38820893 DOI: 10.1016/j.jiph.2024.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/03/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Antimicrobial stewardship (AMS) programs have been differently implemented across Europe. This study primarily aimed to compare AMS in two European regions. Secondarily, the study explored the COVID-19 pandemic impact on surrogate outcome indicators of AMS. METHODS A retrospective observational study was conducted in Piedmont (Italy) and Catalonia (Spain). AMS programs were compared through structure and process indicators in 2021. Changes in surrogate outcome indicators (antimicrobial usage; alcohol-based sanitizer consumption; antimicrobial resistance, AMR) from 2017 to 2021 described the pandemic impact. RESULTS Seventy-eight facilities provided structure and process indicators. Catalonia showed better structure scores (p < 0.001) and less dispersion in both indicators. The greatest areas to improve were accountability (Piedmont) and diversification of strategies (Catalonia). Overall, the regions reported consistent changes in outcome indicators. Antimicrobial usage decreased in 2020, returning to near-pre-pandemic levels in 2021. Alcohol-based sanitizer consumption surged in 2020, then dipped remaining above pre-pandemic levels. AMR trends were minimally affected. CONCLUSIONS The centralized approach of Catalonia ensured consistent attainment of quality objectives across all facilities, but it may limit facility-specific strategies. In Piedmont, accountability remain one of the most critical factors as in previous years. The pandemic did not substantially disrupt surrogate outcome measures of AMS. However, the data on AMR suggest that maintaining vigilance against this issue remains paramount.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Noemi Marengo
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Alessandro Mara
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - José Ramón Paño Pardo
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), Biomedical Research Centre of Aragón (CIBA), Zaragoza, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Sergi Hernandez
- Centro Coordinador Programa VINCat, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Fusté
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing. University of Barcelona, Spain; Department of Pathology and Experimental Therapeutics, University of Barcelona and IDIBELL, Faculty of Medicine and Health Sciences University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Miquel Pujol
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; VINCat Program, Servei Català de la Salut, Barcelona, Spain
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Enric Limón
- Centro Coordinador Programa VINCat, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing. University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Costanza Vicentini
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Mó I, da Silva GJ. Tackling Carbapenem Resistance and the Imperative for One Health Strategies-Insights from the Portuguese Perspective. Antibiotics (Basel) 2024; 13:557. [PMID: 38927223 PMCID: PMC11201282 DOI: 10.3390/antibiotics13060557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Carbapenemases, a class of enzymes specialized in the hydrolysis of carbapenems, represent a significant threat to global public health. These enzymes are classified into different Ambler's classes based on their active sites, categorized into classes A, D, and B. Among the most prevalent types are IMI/NMC-A, KPC, VIM, IMP, and OXA-48, commonly associated with pathogenic species such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. The emergence and dissemination of carbapenemase-producing bacteria have raised substantial concerns due to their ability to infect humans and animals (both companion and food-producing) and their presence in environmental reservoirs. Adopting a holistic One Health approach, concerted efforts have been directed toward devising comprehensive strategies to mitigate the impact of antimicrobial resistance dissemination. This entails collaborative interventions, highlighting proactive measures by global organizations like the World Health Organization, the Center for Disease Control and Prevention, and the Food and Agriculture Organization. By synthesizing the evolving landscape of carbapenemase epidemiology in Portugal and tracing the trajectory from initial isolated cases to contemporary reports, this review highlights key factors driving antibiotic resistance, such as antimicrobial use and healthcare practices, and underscores the imperative for sustained vigilance, interdisciplinary collaboration, and innovative interventions to curb the escalating threat posed by antibiotic-resistant pathogens. Finally, it discusses potential alternatives and innovations aimed at tackling carbapenemase-mediated antibiotic resistance, including new therapies, enhanced surveillance, and public awareness campaigns.
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Affiliation(s)
- Inês Mó
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Gabriela Jorge da Silva
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
- CNC, Center for Neuroscience and Cell Biology, 3004-504 Coimbra, Portugal
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Al Bshabshe A, Algarni A, Shabi Y, Alwahhabi A, Asiri M, Alasmari A, Alshehry A, Mousa WF, Noreldin N. Characterization and Antimicrobial Susceptibility Patterns of Enterococcus Species Isolated from Nosocomial Infections in a Saudi Tertiary Care Hospital over a Ten-Year Period (2012-2021). Diagnostics (Basel) 2024; 14:1190. [PMID: 38893716 PMCID: PMC11171566 DOI: 10.3390/diagnostics14111190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION The Enterococcus genus is a common cause of nosocomial infections, with vancomycin-resistant enterococci (VRE) posing a significant treatment challenge. METHOD This retrospective study, spanning ten years (2012 to 2021), analyzes antimicrobial susceptibility patterns of Enterococcus species from clinical samples in a Saudi Arabian tertiary care hospital. RESULT A total of 1034 Enterococcus isolates were collected, 729 from general wards and 305 from intensive care unit (ICU) patients. VRE accounted for 15.9% of isolates. E. faecalis was the most common species (54.3% of isolates and 2.7% of VRE), followed by E. faecium (33.6% of isolates and 41.2% of VRE). E. faecium exhibited the highest resistance to ciprofloxacin (84.1%), ampicillin (81.6%), and rifampicin (80%), with daptomycin (0.6%) and linezolid (3.1%) showing the lowest resistance. In E. faecalis, ciprofloxacin resistance was highest (59.7%), followed by rifampicin (20.1%) and ampicillin (11.8%). Daptomycin (0%), linezolid (1.5%), and vancomycin (2.7%) had the lowest resistance. VRE cases had higher mortality rates compared to vancomycin-sensitive enterococci (VSE). CONCLUSION Eight different strains of Enterocci were identified. E. faecalis was the most commonly identified strain, while E. faecium had the highest percentage of VRE. VRE cases had a significantly higher mortality rate than VSE cases.
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Affiliation(s)
- Ali Al Bshabshe
- Department of Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Abdullah Algarni
- Department of Family Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia;
| | - Yahya Shabi
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Abdulrahman Alwahhabi
- Department of Internal Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.); (M.A.)
| | - Mohammed Asiri
- Department of Internal Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.); (M.A.)
| | - Ahmed Alasmari
- Department of Internal Medicine, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.); (M.A.)
| | - Adil Alshehry
- Department of Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
| | - Wesam F. Mousa
- Department of Anesthesia and ICU, College of Medicine, Tanta University, Tanta 31512, Egypt
| | - Nashwa Noreldin
- Department of Internal Medicine, College of Medicine, Tanta University, Tanta 31512, Egypt;
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Shen H, Xiao D, Zhang Q, Li S, He H, Dai X, Huang H, Ma W. The features of multidrug-resistant organisms between 2016 and March 2023 and its change after the end of zero-COVID-19 policy in a teaching hospital in Shenzhen, China. J Glob Antimicrob Resist 2024; 37:91-92. [PMID: 38458536 DOI: 10.1016/j.jgar.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND To investigate the clinical distribution and changing trend of antibiotic resistance profiles of multidrug-resistant organisms (MDROs), a retrospective study was undertaken. METHODS The characteristics of MDROs isolated from 2016 to March 2023 were retrospectively analysed. The detection rate of these MDROs was compared prior to COVID-19 (Period 1, 2016-2019), during the COVID-19 pandemic with restrictions (Period 2, 2020-2022), and after the end of zero-policy (Period 3, Jan-March, 2023). Antibiotic-resistant genes were detected. RESULTS The overall detection rates of CRPA, CRAB, CREC, CRKP, MRSA, and VREfm were 22.6%, 22.6%, 1.3%, 4.0%, 19.5%, and 3.1%, respectively. The detection rate of CRAB was significantly lower in Period 2 and 3 compared with Period 1 (P < 0.0001). The detection rate of CRPA and VREfm was significantly increased in Period 3 compared with Period 1 and 2 (P < 0.0001). The resistance rate to ticarcillin/clavulanic acid (TIM) and piperacillin/tazobactam (TZP) has gradually increased in CRPA since 2018. NDM and KPC were the most common carbapenemase genes identified in CREC (60.0%) and CRKP isolates (47.8%), respectively. All the 10 VREfm isolates carried the vanA gene. CONCLUSIONS The detection rate of CRAB has decreased since 2018, but a significantly increased prevalence of CRPA and VREfm was seen after the end of zero-policy. An increasing resistance rate to TIM and TZP was seen in CRPA. NDM, KPC, and vanA were the common genes harboured by CREC, CRKP, and VREfm, respectively. Ongoing surveillance after the COVID-19 era is suggested.
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Affiliation(s)
- Hongwei Shen
- Shenzhen Hospital of Southern Medical University, Shenzhen, China.
| | - Danli Xiao
- Southern Medical University, Guangzhou, China
| | - Qiaomin Zhang
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Shaobo Li
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Haihong He
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Xiaoyan Dai
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Hanlian Huang
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Wen Ma
- Shenzhen Hospital of Southern Medical University, Shenzhen, China.
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Wise MG, Karlowsky JA, Mohamed N, Hermsen ED, Kamat S, Townsend A, Brink A, Soriano A, Paterson DL, Moore LSP, Sahm DF. Global trends in carbapenem- and difficult-to-treat-resistance among World Health Organization priority bacterial pathogens: ATLAS surveillance program 2018-2022. J Glob Antimicrob Resist 2024; 37:168-175. [PMID: 38608936 DOI: 10.1016/j.jgar.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To report trends in carbapenem resistance and difficult-to-treat resistance (DTR) among clinical isolates of Gram-negative priority pathogens collected by the ATLAS global surveillance program from 2018 to 2022. METHODS Reference broth microdilution testing was performed in a central laboratory for 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates collected by a constant set of 157 medical centres in 49 countries in Asia Pacific (APAC), Europe (EUR), Latin America (LATAM), Middle East-Africa (MEA), and North America (NA) regions. MICs were interpreted by 2023 CLSI M100 breakpoints. β-lactamase genes were identified for meropenem-nonsusceptible (MIC ≥2 mg/L) Enterobacterales isolates. RESULTS Carbapenem-resistant Enterobacterales (CRE) detection increased (P < 0.05) in APAC, EUR, LATAM, and MEA regions and decreased in NA, while annual DTR percentages increased in all five regions. Carbapenem-resistant P. aeruginosa (CRPA; decreased in MEA region) and carbapenem-resistant A. baumannii-calcoaceticus complex (CRAB; decreased in MEA region and increased in EUR) remained relatively stable over time in all regions, although notably, annual percentages of CRAB and DTR A. baumannii-calcoaceticus complex isolates were consistently >25 percentage points lower in NA than in other regions. For all regions except NA, the majority of changes in CRE percentages could be attributed to hospital-acquired infections. Among meropenem-nonsusceptible Enterobacterales, KPC was the most frequent carbapenemase in NA and EUR each year. NDM was the most prevalent carbapenemase detected in 2022 in other global regions. CONCLUSION CRE, CRPA, CRAB, and DTR rates vary among global regions over time highlighting the need for continuing surveillance to inform treatment strategies and antimicrobial stewardship.
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Affiliation(s)
| | - James A Karlowsky
- IHMA, Schaumburg, IL; Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Andy Townsend
- Pfizer Hospital Medical Affairs, Pfizer, Congleton, UK
| | - Adrian Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Luke S P Moore
- Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, London, UK; Imperial College Healthcare NHS Trust, North West London Pathology, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, London, UK
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Abubakar U, Salman M. Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies. J Racial Ethn Health Disparities 2024; 11:1308-1329. [PMID: 37157014 PMCID: PMC10166031 DOI: 10.1007/s40615-023-01610-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa. METHODS Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles. RESULTS Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4-83.5%) and North Africa (79.1%) compared to East Africa (27.6-73.7%) and South Africa (33.6-49.7%). The ICU (64.4-100%; n = 9 studies) and the pediatric medical ward (10.6-94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7-61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6-45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4-51.7%; n = 14 studies), metronidazole (14.6-44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6-22.3%), and ampicillin (n = 6 studies; range: 6.0-29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3-97.9%, 1.8-53.5%, and 0.0-5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively. CONCLUSION The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
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Orosz L. When it rains it pours: An increased prevalence of intestinal carriage of vancomycin-resistant Enterococcus faecium related to higher use of oral vancomycin in a tertiary care Hungarian clinical centre during the years of the COVID-19 pandemic. J Glob Antimicrob Resist 2024; 37:129-134. [PMID: 38552874 DOI: 10.1016/j.jgar.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 04/30/2024] Open
Abstract
OBJECTIVES This study aims to investigate the association between oral vancomycin consumption and intestinal vancomycin-resistant Enterococcus carriage in the pre- and COVID era in the clinical centre of the University of Szeged, Hungary. METHODS This retrospective microbiological examination was carried out using electronically collected data, corresponding to the period between 1 January 2018 and 31 December 2022, at the Department of Medical Microbiology. Data included isolated species and the according antimicrobial susceptibility patterns. Annual consumption data for oral vancomycin consumption were exported from the database of the central pharmacy of the clinical centre. As a strain typing procedure, Fourier transform infrared spectroscopy analysis was used. RESULTS There was a significant increase in the number of faecal vancomycin-resistant Enterococcus isolates throughout the study. The prevalence increased significantly during the years of the pandemic. The use of orally administered vancomycin in the clinical centre increased significantly. A strong positive correlation existed between the two phenomena. Several strains with different resistance patterns spread in the clinical centre. Two of these occurred in greater numbers, differing in their high-level aminoglycoside resistance. However, the overall resistance of these strains was stagnating. FTIR analysis revealed that 59 of the 62 strains were also divided into 2 large clusters differing partially in their high-level aminoglycoside resistance. CONCLUSIONS During the pandemic, intestinal VRE carriage among clinical centre patients increased significantly, linked to increased oral vancomycin use. Different strains spread, with aminoglycoside resistance being the primary distinction. This highlights the negative impact of the pandemic on VRE carriage.
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Affiliation(s)
- László Orosz
- Department of Medical Microbiology, University of Szeged, Szeged, Hungary.
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Karakosta P, Vourli S, Kousouli E, Meletis G, Tychala A, Louka C, Vasilakopoulou A, Protonotariou E, Mamali V, Zarkotou O, Skoura L, Pournaras S. Multidrug-resistant organism bloodstream infection and hospital acquisition among inpatients in three tertiary Greek hospitals during the COVID-19 era. Eur J Clin Microbiol Infect Dis 2024; 43:1241-1246. [PMID: 38530465 PMCID: PMC11178613 DOI: 10.1007/s10096-024-04806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
From 2019 (pre-COVID-19) to 2022 (COVID-19 years), three tertiary Greek hospitals monitored MDRO bloodstream infection (BSI) and hospital acquisition relying on laboratory data. Surveillance covered carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA), in intensive care units (ICUs) and non-ICUs. Non-ICUs experienced significant increases in CRE, CRAB and VRE during the pandemic. In ICUs, CRE increased in 2021, CRAB in 2020 and 2021, and VRE in 2021 and 2022. KPC predominated among CRE. MDRO BSI and hospital acquisition incidence rates increased, driven by CRE and CRAB.
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Affiliation(s)
- Polyxeni Karakosta
- Laboratory of Clinical Microbiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vourli
- Laboratory of Clinical Microbiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisavet Kousouli
- Department of Clinical Microbiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Georgios Meletis
- Department of Microbiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Tychala
- Department of Microbiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Louka
- Department of Clinical Microbiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Alexandra Vasilakopoulou
- Laboratory of Clinical Microbiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Protonotariou
- Department of Microbiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Mamali
- Department of Clinical Microbiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Olympia Zarkotou
- Department of Clinical Microbiology, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Lemonia Skoura
- Department of Microbiology, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Pournaras
- Laboratory of Clinical Microbiology, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Viana-Cárdenas E, Triana A, Cárdenas-Álvarez J, Carvajal-Diaz E, Mendoza H, Viasus D. A large multicenter Ralstonia pickettii outbreak in critically ill patients during the COVID-19 pandemic: Epidemiological and clinical characteristics of 66 cases. J Infect Prev 2024; 25:85-88. [PMID: 38584711 PMCID: PMC10998545 DOI: 10.1177/17571774241236250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/12/2024] [Indexed: 04/09/2024] Open
Abstract
Objective To describe a multicenter outbreak of R. pickettii that occurred in a large number of critically ill patients in a city in Colombia, during the COVID-19 pandemic. Methods In April 2021, the National Institute for Food and Drug Surveillance (INVIMA) reported an outbreak of R. pickettii infection associated with contaminated intravenous medications. The Municipal Health Department began collecting data for all cases identified by the hospitals and the results of microbiological studies. Medical records and death certificates of included cases were reviewed. Results Between March and May 2021, 66 cases of R. pickettii bloodstream infections from nine hospitals were documented. The median age of the patients was 60 years (IQR 51-72), and most of them had comorbidities (78.8%), mainly arterial hypertension and diabetes mellitus. At the time of the R. pickettii bloodstream infection, 89.4% had COVID-19, 86.4% were on mechanical ventilation, and 98.5% were receiving corticosteroids. The overall mortality was 81.8%. Nearly 60% of the deaths were related to R. pickettii bloodstream infections. R. pickettii was identified in the cultures from intravenous medications. Conclusions This large multicenter outbreak caused by intravenous medications contaminated with R. pickettii mainly affected critically ill COVID-19 patients. Mortality was high and largely related to R. pickettii bloodstream infection.
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Affiliation(s)
| | - Abel Triana
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Miami, FL, USA
| | | | - Edwin Carvajal-Diaz
- Department of Medicine, Hospital Universidad del Norte, Universidad del Norte, Barranquilla, Colombia
| | - Humberto Mendoza
- Department of Health, Barranquilla City Hall, Barranquilla, Colombia
| | - Diego Viasus
- Department of Medicine, Hospital Universidad del Norte, Universidad del Norte, Barranquilla, Colombia
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Baudet A, Regad M, Gibot S, Conrath É, Lizon J, Demoré B, Florentin A. Pseudomonas aeruginosa Infections in Patients with Severe COVID-19 in Intensive Care Units: A Retrospective Study. Antibiotics (Basel) 2024; 13:390. [PMID: 38786119 PMCID: PMC11117246 DOI: 10.3390/antibiotics13050390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Patients hospitalized in ICUs with severe COVID-19 are at risk for developing hospital-acquired infections, especially infections caused by Pseudomonas aeruginosa. We aimed to describe the evolution of P. aeruginosa infections in ICUs at CHRU-Nancy (France) in patients with severe COVID-19 during the three initial waves of COVID-19. The second aims were to analyze P. aeruginosa resistance and to describe the antibiotic treatments. We conducted a retrospective cohort study among adult patients who were hospitalized for acute respiratory distress syndrome due to COVID-19 and who developed a hospital-acquired infection caused by P. aeruginosa during their ICU stay. Among the 51 patients included, most were male (90%) with comorbidities (77%), and the first identification of P. aeruginosa infection occurred after a median ICU stay of 11 days. Several patients acquired infections with MDR (27%) and XDR (8%) P. aeruginosa strains. The agents that strains most commonly exhibited resistance to were penicillin + β-lactamase inhibitors (59%), cephalosporins (42%), monobactams (32%), and carbapenems (27%). Probabilistic antibiotic treatment was prescribed for 49 patients (96%) and was subsequently adapted for 51% of patients after antibiogram and for 33% of patients after noncompliant antibiotic plasma concentration. Hospital-acquired infection is a common and life-threatening complication in critically ill patients. Efforts to minimize the occurrence and improve the treatment of such infections, including infections caused by resistant strains, must be pursued.
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Affiliation(s)
- Alexandre Baudet
- INSPIIRE, Inserm, Université de Lorraine, F-54000 Nancy, France
- Service d'Odontologie, CHRU-Nancy, F-54000 Nancy, France
| | - Marie Regad
- INSPIIRE, Inserm, Université de Lorraine, F-54000 Nancy, France
- Département Territorial D'hygiène et Prévention du Risque Infectieux, CHRU-Nancy, F-54000 Nancy, France
- Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France
| | - Sébastien Gibot
- Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France
- Service de Médecine Intensive et Réanimation, CHRU-Nancy, F-54000 Nancy, France
| | - Élodie Conrath
- Département Territorial D'hygiène et Prévention du Risque Infectieux, CHRU-Nancy, F-54000 Nancy, France
| | - Julie Lizon
- Département Territorial D'hygiène et Prévention du Risque Infectieux, CHRU-Nancy, F-54000 Nancy, France
| | - Béatrice Demoré
- INSPIIRE, Inserm, Université de Lorraine, F-54000 Nancy, France
- Pharmacie, CHRU-Nancy, F-54000 Nancy, France
- Faculté de Pharmacie, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France
| | - Arnaud Florentin
- INSPIIRE, Inserm, Université de Lorraine, F-54000 Nancy, France
- Département Territorial D'hygiène et Prévention du Risque Infectieux, CHRU-Nancy, F-54000 Nancy, France
- Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France
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Lee YL, Liu CE, Tang HJ, Huang YT, Chen YS, Hsueh PR. Epidemiology and antimicrobial susceptibility profiles of Enterobacterales causing bloodstream infections before and during COVID-19 pandemic: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) in Taiwan, 2018-2021. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00072-0. [PMID: 38632023 DOI: 10.1016/j.jmii.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/01/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has contributed to the spread of antimicrobial resistance, including carbapenem-resistant Enterobacterales. METHODS This study utilized data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program in Taiwan. Enterobacterales from patients with bloodstream infections (BSIs) were collected and subjected to antimicrobial susceptibility testing and β-lactamase gene detection using a multiplex PCR assay. Statistical analysis was conducted to compare susceptibility rates and resistance genes between time periods before (2018-2019) and during the COVID-19 pandemic (2020-2021). RESULTS A total of 1231 Enterobacterales isolates were collected, predominantly Escherichia coli (55.6%) and Klebsiella pneumoniae (29.2%). The proportion of nosocomial BSIs increased during the COVID-19 pandemic (55.5% vs. 61.7%, p < 0.05). Overall, susceptibility rates for most antimicrobial agents decreased, with Enterobacterales from nosocomial BSIs showing significantly lower susceptibility rates than those from community-acquired BSIs. Among 123 Enterobacterales isolates that underwent molecular resistance mechanism detection, ESBL, AmpC β-lactamase, and carbapenemase genes were detected in 43.1%, 48.8% and 16.3% of the tested isolates, respectively. The prevalence of carbapenemase genes among carbapenem-resistant Enterobacterales increased during the pandemic, although the difference was not statistically significant. Two novel β-lactamase inhibitor combinations, imipenem-relebactam and meropenem-vaborbactam, preserved good efficacy against Enterobacterales. However, imipenem-relebactam showed lower in vitro activity against imipenem-non-susceptible Enterobacterales than that of meropenem-vaborbactam. CONCLUSIONS The COVID-19 pandemic appears to be associated with a general decrease in antimicrobial susceptibility rates among Enterobacterales causing BSIs in Taiwan. Continuous surveillance is crucial to monitor antimicrobial resistance during the pandemic and in the future.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Ph.D Program in Medical Biotechnology, National Chung-Hsing University, Taichung, Taiwan
| | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Tsung Huang
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Shen Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Ph.D Program for Ageing, School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Kumari P, Mahmud TS, Ng KTW, Chowdhury R, Gitifar A, Richter A. Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:24480-24491. [PMID: 38441741 DOI: 10.1007/s11356-024-32764-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/29/2024] [Indexed: 04/07/2024]
Abstract
Literature review suggests that studies on biomedical waste generation and disposal behaviors in North America are limited. Given the infectious nature of the materials, effective biomedical waste management is vital to the public health and safety of the residents. This study explicitly examines seasonal variations of treated biomedical waste (TBMW) disposal rates in the City of Regina, Canada, from 2013 to 2022. Immediately before the onset of COVID-19, the City exhibited a steady pattern of TBMW disposal rate at about 6.6 kg∙capita-1∙year-1. However, the COVID-19 pandemic and its associated lockdowns brought about an abrupt and persistent decline in TBMW disposal rates. Inconsistent fluctuations in both magnitude and variability of the monthly TBMW load weights were also observed. The TBMW load weight became particularly variable in 2020, with an interquartile range 4 times higher than 2019. The average TBMW load weight was also the lowest (5.1 tonnes∙month-1∙truckload-1) in 2020, possibly due to an overall decline in non-COVID-19 medical emergencies, cancellation of elective surgeries, and availability of telehealth options to residents. In general, the TBMW disposal rates peaked during the summer and fall seasons. The day-to-day TBMW disposal contribution patterns between the pre-pandemic and post-pandemic are similar, with 97.5% of total TBMW being disposed of on fixed days. Results from this Canadian case study indicate that there were observable temporal changes in TBMW disposal behaviors during and after the COVID-19 lockdowns.
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Affiliation(s)
- Preeti Kumari
- Environmental Systems Engineering, University of Regina, 3737 Wascana Parkway, Regain, SK, S4S 0A2, Canada
| | - Tanvir Shahrier Mahmud
- Environmental Systems Engineering, University of Regina, 3737 Wascana Parkway, Regain, SK, S4S 0A2, Canada
| | - Kelvin Tsun Wai Ng
- Environmental Systems Engineering, University of Regina, 3737 Wascana Parkway, Regain, SK, S4S 0A2, Canada.
| | - Rumpa Chowdhury
- Environmental Systems Engineering, University of Regina, 3737 Wascana Parkway, Regain, SK, S4S 0A2, Canada
| | - Arash Gitifar
- Environmental Systems Engineering, University of Regina, 3737 Wascana Parkway, Regain, SK, S4S 0A2, Canada
| | - Amy Richter
- Environmental Systems Engineering, University of Regina, 3737 Wascana Parkway, Regain, SK, S4S 0A2, Canada
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Kibria MK, Ali MA, Yaseen M, Khan IA, Bhat MA, Islam MA, Mahumud RA, Mollah MNH. Discovery of Bacterial Key Genes from 16S rRNA-Seq Profiles That Are Associated with the Complications of SARS-CoV-2 Infections and Provide Therapeutic Indications. Pharmaceuticals (Basel) 2024; 17:432. [PMID: 38675393 PMCID: PMC11053588 DOI: 10.3390/ph17040432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
SARS-CoV-2 infections, commonly referred to as COVID-19, remain a critical risk to both human life and global economies. Particularly, COVID-19 patients with weak immunity may suffer from different complications due to the bacterial co-infections/super-infections/secondary infections. Therefore, different variants of alternative antibacterial therapeutic agents are required to inhibit those infection-causing drug-resistant pathogenic bacteria. This study attempted to explore these bacterial pathogens and their inhibitors by using integrated statistical and bioinformatics approaches. By analyzing bacterial 16S rRNA sequence profiles, at first, we detected five bacterial genera and taxa (Bacteroides, Parabacteroides, Prevotella Clostridium, Atopobium, and Peptostreptococcus) based on differentially abundant bacteria between SARS-CoV-2 infection and control samples that are significantly enriched in 23 metabolic pathways. A total of 183 bacterial genes were found in the enriched pathways. Then, the top-ranked 10 bacterial genes (accB, ftsB, glyQ, hldD, lpxC, lptD, mlaA, ppsA, ppc, and tamB) were selected as the pathogenic bacterial key genes (bKGs) by their protein-protein interaction (PPI) network analysis. Then, we detected bKG-guided top-ranked eight drug molecules (Bemcentinib, Ledipasvir, Velpatasvir, Tirilazad, Acetyldigitoxin, Entreatinib, Digitoxin, and Elbasvir) by molecular docking. Finally, the binding stability of the top-ranked three drug molecules (Bemcentinib, Ledipasvir, and Velpatasvir) against three receptors (hldD, mlaA, and lptD) was investigated by computing their binding free energies with molecular dynamic (MD) simulation-based MM-PBSA techniques, respectively, and was found to be stable. Therefore, the findings of this study could be useful resources for developing a proper treatment plan against bacterial co-/super-/secondary-infection in SARS-CoV-2 infections.
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Affiliation(s)
- Md. Kaderi Kibria
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
- Department of Statistics, Hajee Mohammad Danesh Science and Technology University, Dinajpur 5200, Bangladesh
| | - Md. Ahad Ali
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
- Department of Chemistry, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Muhammad Yaseen
- Institute of Chemical Sciences, University of Swat, Main Campus, Charbagh 19130, Pakistan;
| | - Imran Ahmad Khan
- Department of Chemistry, Government College University, Faisalabad 38000, Pakistan;
| | - Mashooq Ahmad Bhat
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11421, Saudi Arabia;
| | - Md. Ariful Islam
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
| | - Rashidul Alam Mahumud
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
| | - Md. Nurul Haque Mollah
- Bioinformatics Laboratory, Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh; (M.K.K.); (M.A.A.); (M.A.I.)
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Pezzani MD, Arieti F, Rajendran NB, Barana B, Cappelli E, De Rui ME, Galia L, Hassoun-Kheir N, Argante L, Schmidt J, Rodriguez-Bano J, Harbarth S, de Kraker M, Gladstone BP, Tacconelli E. Frequency of bloodstream infections caused by six key antibiotic-resistant pathogens for prioritization of research and discovery of new therapies in Europe: a systematic review. Clin Microbiol Infect 2024; 30 Suppl 1:S4-S13. [PMID: 38007387 DOI: 10.1016/j.cmi.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND To prioritize healthcare investments, ranking of infections caused by antibiotic-resistant bacteria should be based on accurate incidence data. OBJECTIVES We performed a systematic review to estimate frequency measures of antimicrobial resistance for six key bacteria causing bloodstream infections (BSI) in European countries. DATA SOURCES We searched PubMed, Web of Science, Embase databases, and the ECRAID-Base Epidemiological-Network platform. STUDY ELIGIBILITY CRITERIA We included studies and surveillance systems assessing resistance-percentage, prevalence, or incidence-density of BSI because of carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli, third-generation cephalosporins-resistant E. coli and K. pneumoniae, vancomycin-resistant Enterococcus faecium, and methicillin-resistant Staphylococcus aureus. METHODS Reviewers independently assessed published data and evaluated study quality with the modified Joanna Briggs Institute critical appraisal tool. Pooled estimates were determined using random effects meta-analysis. Consistency of data was assessed using random effects meta-regression (Wald test, p > 0.05). RESULTS We identified 271 studies and 52 surveillance systems from 32 European countries. Forty-five studies (16%) reported on BSI, including 180 frequency measures most commonly as resistance-percentage (88, 48.9%). Among 309 frequency measures extracted from 24 (46%) surveillance systems, 278 (89%) were resistance-percentages. Frequency measures of methicillin-resistant S. aureus and vancomycin-resistant E. faecium BSI were more frequently reported from Southern Europe and Western Europe (80%), whereas carbapenem-resistant P. aeruginosa BSI from Northern Europe and Western Europe (88%). Highest resistance-percentages were detected for carbapenem-resistant A. baumannii (66% in Central Eastern Europe) and carbapenem-resistant K. pneumoniae (62.8% in Southern Europe). Pooled estimates showed lower resistance-percentages in community versus healthcare-associated infections and in children versus adults. Estimates from studies and surveillance systems were mostly consistent among European regions. The included data was of medium quality. DISCUSSION Pathogen-specific frequency measures of antimicrobial resistance in BSI are insufficient to inform antibiotic stewardship and research and development strategies. Improving data collection and standardization of frequency measures is urgently needed.
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Affiliation(s)
- Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Fabiana Arieti
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nithya Babu Rajendran
- Infectious Diseases, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Benedetta Barana
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Eva Cappelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Elena De Rui
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Liliana Galia
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nasreen Hassoun-Kheir
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Lorenzo Argante
- Department of Bacterial Vaccine Epidemiology, GSK, Siena, Italy
| | | | - Jesus Rodriguez-Bano
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain; Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla/CSIC, Seville, Spain; CIBERINFEC, Madrid, Spain
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlieke de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Beryl Primrose Gladstone
- Infectious Diseases, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany; DZIF-Clinical Research Unit, Infectious Diseases, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; DZIF-Clinical Research Unit, Infectious Diseases, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
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Mrvič T, Stevanoska S, Beović B, Logar M, Gregorčič S, Žnidaršič B, Seme K, Velimirović I, Švent Kučina N, Maver Vodičar P, Križan Hergouth V, Džeroski S, Pirs M. The Impact of COVID-19 on Multidrug-Resistant Bacteria at a Slovenian Tertiary Medical Center. Antibiotics (Basel) 2024; 13:214. [PMID: 38534649 DOI: 10.3390/antibiotics13030214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/28/2024] Open
Abstract
The COVID-19 pandemic has strained healthcare systems globally. Shortages of hospital beds, reassignment of healthcare workers to COVID-19-dedicated wards, an increased workload, and evolving infection prevention and control measures have potentially contributed to the spread of multidrug-resistant bacteria (MDRB). To determine the impact of the COVID-19 pandemic at the University Medical Center Ljubljana, a tertiary teaching hospital, we analyzed the monthly incidence of select bacterial species per patient from 2018 to 2022. The analysis was performed for all isolates and for MDRB isolates. The data were analyzed separately for isolates from all clinical samples, from blood culture only, and from clinical and surveillance samples. Our findings revealed an increased incidence density of patients with Enterococcus faecium, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa isolates from clinical samples during the COVID-19 period in the studied hospital. Notably, the incidence density of MDRB isolates-vancomycin-resistant E. faecium, extended-spectrum betalactamase-producing K. pneumoniae, and betalactam-resistant P. aeruginosa-from clinical samples increased during the COVID-19 period. There were no statistically significant differences in the incidence density of patients with blood culture MDRB isolates. We observed an increase in the overall MDRB burden (patients with MDRB isolates from both clinical and surveillance samples per 1000 patient days) in the COVID-19 period in the studied hospital for vancomycin-resistant E. faecium, carbapenem-resistant K. pneumoniae, and betalactam-resistant P. aeruginosa and a decrease in the methicillin-resistant S. aureus burden.
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Affiliation(s)
- Tatjana Mrvič
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mateja Logar
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sergeja Gregorčič
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Benica Žnidaršič
- Infection Prevention and Control Unit, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Katja Seme
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Ivana Velimirović
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Švent Kučina
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Maver Vodičar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Veronika Križan Hergouth
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Mateja Pirs
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Haddad N, Zeenny RM, El Halabi C, Abdallah T, El Helou R, Zahreddine NK, Kanj SS, Rizk NA. The experience of an antimicrobial stewardship program and antibiotic consumption and resistance trends during the COVID-19 pandemic at a tertiary care center in Beirut. J Infect Public Health 2024; 17:254-262. [PMID: 38128409 DOI: 10.1016/j.jiph.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Antimicrobial Resistance, a global concern, worsened with the COVID-19 pandemic that caused a surge of critically ill patients, increased antimicrobial consumption, and the spread of infections with multidrug-resistant organisms (MDROs). Antimicrobial Stewardship Programs (ASP) aim to optimize antimicrobial utilization to fight resistance. We aim to describe the ASP experience and to study antimicrobial consumption and MDRO rates among COVID-19 patients at a tertiary care center in Beirut. METHODS We compiled the ASP interventions, defined as ASP team recommendations, from January 2019 until December 2021. Data on antimicrobial consumption, expressed as a defined daily dose (DDD) per 100 patient days, was collected per quarter for all antimicrobials and restricted antimicrobials per ASP guidance. Our primary objective was to report on the ASP experience, and the secondary objective was to reflect on the rates of MDROs among hospitalized COVID-19 patients with respiratory or bloodstream bacterial co-infections between March 2020 and September 2021. RESULTS 9922 ASP interventions were documented during this study period, with a noticeable correlation between COVID-19 surges in Lebanon and the number of ASP interventions. Acceptance rates for these recommendations improved over time, with a noticeable decrease in the proportion of interventions related to de-escalation and discontinuation of broad-spectrum antimicrobials. We noted an increase in all antimicrobial consumption after the onset of the pandemic, peaking in Q4 2020 (142.8 DDD of anti-infectives/100 patient days) and Q1 2021 (79.1 DDD of restricted anti-infectives/100 patient days). As expected, MDROs, particularly ESKAPE organisms (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Carbapenem-resistant Enterobacteriaceae) accounted for 24% of isolates obtained from this cohort. CONCLUSION This study highlights the experience of the ASP as we adapted to the COVID-19 pandemic. The ASP team maintained its operations and continued to monitor antibiotic consumption and provide recommendations to limit antibiotic misuse in an effort to mitigate the impact of the pandemic on antimicrobial resistance.
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Affiliation(s)
- Nisrine Haddad
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rony M Zeenny
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Celia El Halabi
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Abdallah
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Remie El Helou
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada Kara Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Nesrine A Rizk
- Division of Infectious Diseases, Department of Internal Medicine, Center for Infectious Diseases Research, American University of Beirut Medical Center, Beirut, Lebanon.
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Patjas A, Martelius A, Ollgren J, Kantele A. International travel increases risk of urinary tract infection caused by extended-spectrum beta-lactamase-producing Enterobacterales-three-arm case-control study. J Travel Med 2024; 31:taad155. [PMID: 38123504 DOI: 10.1093/jtm/taad155] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) have worldwide become increasingly prevalent as pathogens causing urinary tract infections (UTIs), posing challenges in their treatment. Of particular concern are travellers to low- and middle-income countries (LMICs), a substantial proportion of whom become colonized by ESBL-PE, with UTIs as the most common clinical manifestation. Seeking tools for preventing ESBL-PE UTI, we explored factors associated with (i) any UTI (versus control), (ii) ESBL-PE UTI (versus control) and (iii) ESBL-PE versus non-ESBL-PE UTI. METHODS During 2015-20, we recruited patients with recent ESBL-PE or non-ESBL-PE UTIs, and controls with no UTI to fill in questionnaires covering potential (ESBL-PE-)UTI risk factors. RESULTS Of our 430 participants, 130 had ESBL-PE UTI and 187 non-ESBL-PE UTI; 113 were controls. Our three comparisons showed several risk factors as exemplified for any UTI versus controls by female sex, lower education, age, diabetes, antibiotic use, diarrhoea; for ESBL-PE UTI versus controls by travel to LMICs, antibiotic use, swimming; and ESBL-PE versus non-ESBL-PE UTI by male sex, higher education, LMIC travel (participant/household member), pets and antibiotic use. Weekly fish meals appeared protective against both UTI and ESBL-PE UTI. CONCLUSIONS Of the numerous factors predisposing to UTI and/or ESBL-PE UTI, our study highlights antibiotic use and LMIC travel. Household members' LMIC travel appears to pose a risk of ESBL-PE UTI, pointing to household transmission of travel-acquired uropathogens. As predisposing factors to multidrug-resistant UTI, international travel and antibiotic use constitute practical targets for prevention efforts.
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Affiliation(s)
- Anu Patjas
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Antimicrobial Resistance Research, FIMAR, Helsinki, Finland
| | - Antti Martelius
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Kantele
- Meilahti Vaccine Research Centre, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Unit, University of Helsinki, Helsinki, Finland
- Centre of Excellence in Antimicrobial Resistance Research, FIMAR, Helsinki, Finland
- Travel Clinic, Aava Medical Centre, Helsinki, Finland
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Hernández-Silva G, Corzo-León DE, Becerril-Vargas E, Peralta-Prado AB, Odalis RG, Morales-Villarreal F, Ríos-Ayala MA, Alonso TG, Agustín FLD, Ramón AF, Hugo ATV. Clinical characteristics, bacterial coinfections and outcomes in COVID-19-associated pulmonary aspergillosis in a third-level Mexican hospital during the COVID-19 pre-vaccination era. Mycoses 2024; 67:e13693. [PMID: 38214372 DOI: 10.1111/myc.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Damage due to respiratory viruses increases the risk of bacterial and fungal coinfections and superinfections. High rates of invasive aspergillosis are seen in severe influenza and COVID-19. This report describes CAPA cases diagnosed during the first wave in the biggest reference centre for severe COVID-19 in Mexico. OBJECTIVES To describe the clinical, microbiological and radiological characteristics of patients with invasive pulmonary aspergillosis associated with critical COVID-19, as well as to describe the variables associated with mortality. METHODS This retrospective study identified CAPA cases among individuals with COVID-19 and ARDS, hospitalised from 1 March 2020 to 31 March 2021. CAPA was defined according to ECMM/ISHAM consensus criteria. Prevalence was estimated. Clinical and microbiological characteristics including bacterial superinfections, antifungal susceptibility testing and outcomes were documented. RESULTS Possible CAPA was diagnosed in 86 patients among 2080 individuals with severe COVID-19, representing 4.13% prevalence. All CAPA cases had a positive respiratory culture for Aspergillus species. Aspergillus fumigatus was the most frequent isolate (64%, n = 55/86). Seven isolates (9%, n = 7/80) were resistant to amphotericin B (A. fumigatus n = 5/55, 9%; A. niger, n = 2/7, 28%), two A. fumigatus isolates were resistant to itraconazole (3.6%, n = 2/55). Tracheal galactomannan values ranged between 1.2 and 4.05, while serum galactomannan was positive only in 11% (n = 3/26). Bacterial coinfection were documented in 46% (n = 40/86). Gram negatives were the most frequent cause (77%, n = 31/40 isolates), from which 13% (n = 4/31) were reported as multidrug-resistant bacteria. Mortality rate was 60% and worse prognosis was seen in older persons, high tracheal galactomannan index and high HbA1c level. CONCLUSIONS One in 10 individuals with CAPA carry a resistant Aspergillus isolate and/or will be affected by a MDR bacteria. High mortality rates are seen in this population.
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Affiliation(s)
- Graciela Hernández-Silva
- Infectious Diseases Department, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Eduardo Becerril-Vargas
- Microbiology Clinical Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Amy Bethel Peralta-Prado
- Research Centre of Infectious Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Rodríguez-Ganes Odalis
- Pharmacology Department, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | | | | | | | - Avilez-Félix Ramón
- Pneumology Service, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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Thomsen J, Abdulrazzaq NM, The UAE AMR Surveillance Consortium, Everett DB, Menezes GA, Senok A, Ayoub Moubareck C. Carbapenem resistant Enterobacterales in the United Arab Emirates: a retrospective analysis from 2010 to 2021. Front Public Health 2023; 11:1244482. [PMID: 38145078 PMCID: PMC10745492 DOI: 10.3389/fpubh.2023.1244482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/24/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) are spreading in the United Arab Emirates (UAE) where their dissemination is facilitated by international travel, trade, and tourism. The objective of this study is to describe the longitudinal changes of CRE as reported by the national AMR surveillance system of the UAE. METHODS In this study, we retrospectively describe CRE isolated from 317 surveillance sites, including 87 hospitals and 230 centers/clinics from 2010 to 2021. The associated clinical, demographic, and microbiological characteristics are presented by relying on the UAE national AMR surveillance program. Data was analyzed using WHONET microbiology laboratory database software (http://www.whonet.org). RESULTS A total of 14,593 carbapenem resistant Enterobacterales were analyzed, of which 48.1% were carbapenem resistant Klebsiella pneumoniae (CRKp), 25.1% carbapenem resistant Escherichia coli (CREc), and 26.8% represented 72 other carbapenem resistant species. Carbapenem resistant strains were mostly associated with adults and isolated from urine samples (36.9% of CRKp and 66.6% of CREc) followed by respiratory samples (26.95% for CRKp) and soft tissue samples (19.5% for CRKp). Over the studied period carbapenem resistance rates remained high, especially in K. pneumoniae, and in 2021 were equivalent to 67.6% for imipenem, 76.2% for meropenem, and 91.6% for ertapenem. Nevertheless, there was a statistically significant decreasing trend for imipenem and meropenem resistance in Klebsiella species (p < 0.01) while the decrease in ertapenem resistance was non-significant. Concerning E. coli, there was a statistically significant decreasing trend for meropenem and imipenem resistance over the 12 years, while ertapenem resistance increased significantly with 83.8% of E. coli exhibiting ertapenem resistance in 2021. Resistance rates to ceftazidime and cefotaxime remained higher than 90% (in 2021) for CRKp and cefotaxime rates increased to 90.5% in 2021 for CREc. Starting 2014, resistance to colistin and tigecycline was observed in carbapenem resistant Enterobacterales. CRE were associated with a higher mortality (RR: 6.3), admission to ICU (RR 3.9), and increased length of stay (LOS; 10 excess inpatient days per CRE case). CONCLUSION This study supports the need to monitor CRE in the UAE and draws attention to the significant increase of ertapenem resistance in E. coli. Future surveillance analysis should include a genetic description of carbapenem resistance to provide new strategies.
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Affiliation(s)
- Jens Thomsen
- Abu Dhabi Public Health Center, Abu Dhabi, United Arab Emirates
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | | | - Dean B. Everett
- Department of Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, United Arab Emirates
- Biotechnology Research Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Infection Research Unit, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Godfred Antony Menezes
- Department of Medical Microbiology and Immunology, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
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Tenderenda A, Łysakowska ME, Gawron-Skarbek A. The Prevalence of Alert Pathogens and Microbial Resistance Mechanisms: A Three-Year Retrospective Study in a General Hospital in Poland. Pathogens 2023; 12:1401. [PMID: 38133286 PMCID: PMC10746124 DOI: 10.3390/pathogens12121401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The development of antibiotic resistance mechanisms hinders the treatment process. So far, there is limited data on the problem of bacterial resistance in hospitals in Central and Eastern Europe. Therefore, this study aimed to assess the prevalence of resistance mechanisms and alert pathogens based on reports regarding cultures of samples collected from general hospital patients in Poland in the period 2019-2021. This study examined the prevalence of resistance mechanisms and alert pathogens and the structure of microorganisms, including the type of diagnostic material in the hospital department. The frequency of occurrence and the trends were analysed based on Cochran's Q-test, relative change and the average annual rate of change (AARC). Of all 14,471 cultures, 3875 were positive for bacteria, and 737 were characterised by resistance mechanisms (19.0%). Alert pathogens were identified in 983 cases (24.6%), including pathogens isolated from blood samples. The most commonlyisolated bacteria were Escherichia coli (>20% of positive cultures), Enterococcus faecalis (7%), and Klebsiella pneumoniae (6%) increasing over time; Staphylococcus aureus (13%) was also found, but its proportion was decreasing over time. Extended-spectrum β-lactamase (ESBL) was the most frequent resistance mechanism in Internal Medicine (IM) (p < 0.001) and the Intensive Care Unit (ICU) (p < 0.01), as well as in ICU-COVID; this increased over the study period (AARC ↑34.9%). Methicillin-resistant Staphylococcus aureus (MRSA) (AARC ↓50.82%) and AmpC beta-lactamase (AARC ↓24.77%) prevalence fell over time. Also, the number of alert pathogens was dominant in the IM (p < 0.01) and ICU (p < 0.001). The most common alert pathogen was ESBL-positive E. coli. Gram-negative rods constitute a significant epidemiological problem in hospitals, especially the growing trend of ESBL in IM and ICU, which calls for increased control of sanitary procedures.
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Affiliation(s)
- Anna Tenderenda
- Department of Geriatrics, Medical University of Lodz, 90-647 Lodz, Poland;
| | - Monika Eliza Łysakowska
- Department of Microbiology and Medical Laboratory Immunology, Medical University of Lodz, 90-213 Lodz, Poland
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50
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Abubakar U, Awaisu A, Khan AH, Alam K. Impact of COVID-19 Pandemic on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1600. [PMID: 37998802 PMCID: PMC10668951 DOI: 10.3390/antibiotics12111600] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
This study investigated how the Coronavirus Disease 2019 (COVID-19) pandemic has affected the rate of healthcare-associated infections (HAIs). PubMed, Scopus and Google Scholar were searched to identify potentially eligible studies published from December 2019 to September 2022. A random effect model was used to determine the changes in the rate of HAIs during the pandemic. Thirty-seven studies, mostly from the United States (n = 13), were included. Fifteen studies described how the pandemic affected the rate of CLABSIs and CAUTIs, and eight of them showed a significant increase in CLABSIs. The risk of CLABSIs and CDIs was 27% (pooled odds ratio [OR]: 0.73; confidence interval [CI]: 0.61-0.89; p < 0.001) and 20% (pooled OR: 1.20; CI: 1.10-1.31; p < 0.001) higher during the pandemic compared to before the COVID-19 pandemic period, respectively. However, the overall risk of HAIs was unaffected by the pandemic (pooled OR: 1.00; 95 CI: 0.80-1.24; p = 0.990). Furthermore, there were no significant changes in the risk of CAUTIs (pooled OR: 1.01; 95 CI: 0.88-1.16; p = 0.890), and SSIs (pooled OR: 1.27; CI: 0.91-1.76; p = 0.16) between the two periods. The COVID-19 pandemic had no effect on the overall risk of HAIs among hospitalized patients, but an increased risk of CLABSIs and CDI were observed during the pandemic. Therefore, more stringent infection control and prevention measures and prudent interventions to promote the rational use of antibiotics are warranted across all healthcare facilities to reduce the burden of HAIs.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
| | - Khurshid Alam
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
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