1
|
Cento V, Carloni S, Sarti R, Bussini L, Asif Z, Morelli P, De Fazio F, Tordato FM, Casana M, Mondatore D, Desai A, Generali E, Pugliese N, Costantini E, Vanoni M, Cecconi M, Aliberti S, Da Rin G, Casari E, Bartoletti M, Voza A. Epidemiology and Resistance Profiles of Bacteria Isolated From Blood Samples in Septic Patients at Emergency Department Admission: A 6-Year Single Centre Retrospective Analysis From Northern Italy. J Glob Antimicrob Resist 2025; 41:202-210. [PMID: 39805348 DOI: 10.1016/j.jgar.2024.12.023] [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: 09/13/2024] [Revised: 11/29/2024] [Accepted: 12/07/2024] [Indexed: 01/16/2025] Open
Abstract
OBJECTIVE This study aimed to investigate the microbiological and clinical heterogeneity of community-onset bloodstream infections (BSIs) and identify features to support targeted empirical antibiotic therapy in the Emergency Department (ED). METHODS Clinical and microbiological data from 992 BSI cases (1,135 isolates) diagnosed within 24 h of ED admission at IRCCS Humanitas Research Hospital, Milan, Italy (January 2015-June 2022), were analysed. Drug resistance was interpreted using EUCAST-2023. Clinical features included age, sex, comorbidities (e.g., cancer, diabetes), infection source, presence of central venous catheters (CVC), ongoing therapies, and sepsis severity. Microbiological data included pathogen identification and antimicrobial susceptibility. RESULTS Antibiotic-susceptible Escherichia coli (29.5%) was the most common isolate, including extended-spectrum beta-lactamase (ESBL)-producing strains (11.3%), followed by methicillin-susceptible Staphylococcus aureus (MSSA, 8.4%). BSIs due to E. coli were more frequent in patients >60 years (43.9% vs. 27.3%, P < 0.001) and associated with ESBL production (OR = 2.202, P = 0.031) and urosepsis (OR = 1.688, P = 0.006). Younger patients (≤60 years) had more S. aureus-associated BSIs (22.4% vs. 10.8%, P < 0.001) and methicillin resistance (7.9% vs. 3.6%, P = 0.021). Carbapenem-resistant Enterobacterales were rare (2.1%-2.8%), predominantly involving Klebsiella pneumoniae. Onco-hematological patients had a lower multidrug-resistance prevalence (9.5% vs. 21.1%, P < 0.001). CONCLUSIONS Community-onset BSIs demonstrated substantial prevalence of resistant pathogens, including ESBL and MRSA, emphasizing the need for robust surveillance systems. Age is a critical factor in guiding empirical antibiotic therapy in the ED.
Collapse
Affiliation(s)
- Valeria Cento
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sara Carloni
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Riccardo Sarti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Linda Bussini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Zian Asif
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paola Morelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Federica Maria Tordato
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Antonio Desai
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Generali
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | - Massimo Vanoni
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maurizio Cecconi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Aliberti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giorgio Da Rin
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Erminia Casari
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Michele Bartoletti
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonio Voza
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| |
Collapse
|
2
|
Karakoç-Parlayan HN, Bulut D, Haykır-Solay A, Kuzi S, Arıkan T, Şencan İ. An Analysis of Bacterial Infection Distribution in the Elderly, and Their Clinical and Laboratory Profiles: Aging and Bacterial Infection. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2025; 7:47-57. [PMID: 40225705 PMCID: PMC11991712 DOI: 10.36519/idcm.2025.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/11/2025] [Indexed: 04/15/2025]
Abstract
Objective The increasing proportion of the elderly population necessitates the development of strategies for managing infections encountered by this group. We aimed to examine the distribution of bacterial infections, their clinical presentations, treatments used, and in-hospital mortality rates among elderly patients. Materials and Methods We examined a cohort aged 65-79 (Group 1) and aged 80 and above (Group 2) with bacterial infections. Demographic characteristics, underlying conditions, clinical/laboratory findings, and mortality rates of the cases were compared. Results The study included 177 patients, of which 44.6% were female, and the mean age was 76.0 ± 8.8 years. Group 2 included 36.7% of the study population with a higher incidence of sepsis and urinary system infections (p=0.038 and p=0.037, respectively). On the other hand, skin and soft tissue infections (42%) emerged as the predominant cause of hospital admissions in Group 1 (p<0.001). Fatigue and dysuria were more frequent in Group 2 (p=0.008 and p=0.044, respectively), and erythema was more common in Group 1 (p=0.012). Hypertension (58.2%) was the most frequently observed comorbidity. Neurological diseases/dementia were more common in Group 2 than in Group 1 (p=0.036). Also, a delayed procalcitonin response to antibiotics was noted in Group 2 (p=0.006). Beta-lactam/beta-lactamase inhibitors were the most frequently used antibiotics, and cephalosporin antibiotics were preferred to a greater extent in Group 2 (p=0.02). Conclusion The increased rates of urinary tract infections and sepsis in individuals over 80 underscores the need for vigilant clinical oversight. Effectively managing underlying conditions can reduce the incidence of some infections in vulnerable groups.
Collapse
Affiliation(s)
- Hanife Nur Karakoç-Parlayan
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Türkiye
- Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Dilek Bulut
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Aslı Haykır-Solay
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Semanur Kuzi
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Türkiye
| | - Tuğba Arıkan
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Türkiye
| | - İrfan Şencan
- Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Türkiye
| |
Collapse
|
3
|
Zhao M, Ouyang Y, Mei J, Liu H. Enhancing pathogens detection in suspected geriatric bloodstream infections using Nanopore-targeted sequencing. Microbiol Spectr 2025; 13:e0155424. [PMID: 39576187 PMCID: PMC11705817 DOI: 10.1128/spectrum.01554-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 10/17/2024] [Indexed: 01/11/2025] Open
Abstract
Bloodstream infections (BSIs) are a critical concern for elderly patients, where prompt and accurate diagnosis is vital for effective treatment. Traditional blood culture methods suffer from delayed results and susceptibility to false-negatives. Nanopore-targeted sequencing (NTS) offers rapid pathogen detection and reporting, presenting a promising alternative. However, the application of NTS for diagnosing suspected BSIs in geriatric patients remains insufficiently studied. We conducted a retrospective cohort study from January 2022 to January 2024, including 198 geriatric patients suspected of BSIs. We utilized NTS to detect pathogen characteristics and compared the effectiveness and consistency of NTS with simultaneous blood culture testing for pathogen detection. NTS demonstrated a pathogen detection rate of 61.1%. The most common bacterial pathogens were Escherichia coli and Staphylococcus aureus (each 7.7%), while Candida albicans was the most prevalent fungal pathogen (30%). Mixed-bacterial infections were detected in 21.7% of NTS-positive cases, and concurrent bacterial-fungal infections were observed in 9.92% of these cases. NTS-positive patients had higher rates of comorbidities, elevated inflammatory markers, and worse prognoses compared to NTS-negative patients. NTS exhibited a significantly higher pathogen detection rate and faster turnaround time than blood culture (78.1% vs 42.2%, P < 0.001), with an agreement rate of 65.6%. The elderly BSI patients frequently involve multiple or mixed infections and correlate with poorer prognoses. NTS provides a faster and more sensitive diagnostic alternative to traditional blood culture, potentially improving clinical outcomes and guiding more effective treatment strategies. This study highlights the need for further research to validate the routine clinical integration of NTS for managing BSIs in geriatric populations. IMPORTANCE Bloodstream infections (BSIs) in elderly patients pose substantial diagnostic and therapeutic challenges due to the limitations of traditional blood culture methods, which are hampered by slow turnaround times and false-negatives. Nanopore-targeted sequencing (NTS) emerges as a significant advancement, offering rapid and accurate pathogen detection directly from blood samples. This study demonstrates that NTS provides a higher detection rate and faster results than conventional blood cultures, crucial for the timely management of BSIs in geriatric patients, who often present with multiple or mixed infections and have poorer clinical outcomes. The findings underscore the potential of NTS to enhance diagnostic accuracy and speed, informing more effective treatment strategies and improving overall patient outcomes. Further research is essential to establish NTS as a routine diagnostic tool in the clinical management of BSIs in the elderly.
Collapse
Affiliation(s)
- Menghui Zhao
- Department of Clinical Laboratory,, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China
- Medical Research Institute, Frontier Science Center for lmmunology and Metabolism, Wuhan University, Wuhan, China
| | - Yan Ouyang
- Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, China
| | - Junchi Mei
- Department of Clinical Laboratory,, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hang Liu
- Department of Clinical Laboratory,, Institute of Translational Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
4
|
Hara Y, Tanno D, Toyokawa M, Takano Y, Ohashi K, Harada R, Suzuki H, Usui M, Yui S, Kobari S, Kitabatake M, Hidaka T, Soya Y, Nakamura K, Kanemitsu K. Evaluation of a nucleic acid amplification system, GENECUBE, for rapid detection of staphylococcal nuc and mecA in blood culture samples. J Microbiol Methods 2024; 227:107063. [PMID: 39448036 DOI: 10.1016/j.mimet.2024.107063] [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: 09/25/2024] [Revised: 10/20/2024] [Accepted: 10/21/2024] [Indexed: 10/26/2024]
Abstract
OBJECTIVE This study determined whether the GENECUBE rapid nucleic acid amplification test could directly detect nuc and mecA genes in clinical blood culture samples of Staphylococcus and various other pathogens. METHODS Between September 2020 and December 2021, 537 blood culture samples from 192 patients with suspected bacteremia were tested using conventional assays (MicroScan WalkAway96 or VITEK 2 systems) and GENECUBE nuc and mecA assays. Isolates from samples with discrepant results between the conventional and GENECUBE assays were further evaluated using MALDI-TOF mass spectrometry, disk diffusion testing using cefoxitin, broth microdilution testing using oxacillin, and sequencing for mecA. Bacterial solutions containing a mixture of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus epidermidis (MRSE) were prepared to evaluate the limit of detection (LOD) of mecA. RESULTS Using conventional assays as the reference, the sensitivity, specificity, and positive and negative predictive values (95 % confidence interval) of GENECUBE were 100 % (96.8-100 %), 100 % (99.1-100 %), 100 % (96.8-100 %), and 100 % (99.1-100 %), respectively, for nuc detection and 100 % (96.1-100 %), 98.9 % (97.4-99.6 %), 94.9 % (88.5-98.3 %), and 100 % (99.2-100 %), respectively, for mecA detection. Sequencing analysis of five samples identified as methicillin-sensitive staphylococci using conventional assays and methicillin-resistant staphylococci using GENECUBE revealed the presence of methicillin-resistant isolates in all samples. The estimated LOD of mecA was 104 colony-forming units (CFU)/mL of MRSE with GENECUBE, compared with 105 CFU/mL with conventional assays. CONCLUSION The GENECUBE assay accurately detected mecA in positive blood culture samples and had higher sensitivity than conventional assays.
Collapse
Affiliation(s)
- Yasuka Hara
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Infection Control Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Daiki Tanno
- Department of Clinical Laboratory Sciences, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima 960-8516, Japan.
| | - Masahiro Toyokawa
- Department of Clinical Laboratory Sciences, School of Health Sciences, Fukushima Medical University, 10-6 Sakaemachi, Fukushima 960-8516, Japan.
| | - Yukiko Takano
- Department of Clinical Laboratory, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Kazutaka Ohashi
- Department of Clinical Laboratory, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Rie Harada
- Department of Clinical Laboratory, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Hiroko Suzuki
- Clinical Microbiology Laboratory, Ohta-Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama 963-8558, Japan.
| | - Mariko Usui
- Infection Control Unit, Ohta-Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama 963-8558, Japan.
| | - Suguru Yui
- Infection Control Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Shuko Kobari
- Infection Control Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Mitsuki Kitabatake
- Infection Control Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Tomoo Hidaka
- Department of Hygiene and Preventive Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| | - Yoshihiro Soya
- Diagnostic System Department, TOYOBO Co., Ltd., 1-13-1 Umeda, Osaka 530-0001, Japan.
| | - Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Infection Control Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan; Department of Laboratory Medicine and Infectious Disease, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba 028-3695, Japan.
| | - Keiji Kanemitsu
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Infection Control Unit, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima 960-1295, Japan.
| |
Collapse
|
5
|
Amodio E, Pizzo S, Vella G, De Francisci V, Distefano SA, Giambelluca E, Graceffa D, Verso MG, Piro E, Giuffrè M, Giammanco GM, Calamusa G. Increase of multidrug-resistant bacteria after the COVID-19 pandemic in a major teaching Hospital in Sicily (2018-2021). Int J Antimicrob Agents 2024; 63:107123. [PMID: 38408493 DOI: 10.1016/j.ijantimicag.2024.107123] [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: 09/08/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has further highlighted the continuing threat of antimicrobial resistance (AMR) to global health and economic development. In the last two decades, AMR has raised increasing concern, with an estimated 4.95 million deaths globally due to bacterial AMR in 2019 alone. The aim of this study was to analyse the impact of the pandemic on the spread of multidrug-resistant organisms (MDROs) using data from the Hospital "P. Giaccone" in Palermo, comparing pre-pandemic and pandemic periods. METHODS This observational study involved adult patients who were discharged from the hospital between 01 January 2018 and 31 December 2021. Hospital Discharge Cards were linked with microbiological laboratory reports to assess MDRO isolations. SARS-CoV-2 positivity during hospitalisation was evaluated using the National Institute of Health surveillance system. RESULTS A total of 58 427 hospitalisations were evaluated in this study. Half the patients were aged over 65 years (N=26 984) and most admissions were in the medical area (N=31 716). During the hospitalisation period, there were 2681 patients (5%) with MDROs isolations, and 946 patients (2%) were positive for SARS-CoV-2. Multivariable analyses showed that during 2020 and 2021, there was a significantly increased risk of isolation of Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Age, weight of the Diagnosis-Related Group (DRG), wards with higher intensity of care, and length-of-stay were associated with a higher risk of MDRO isolation. CONCLUSION This study provides new insights into the impact of the COVID-19 pandemic on MDRO isolation and has important implications for infection control and prevention efforts in healthcare facilities. Age, DRG-weight, and longer hospital stays further increased the risk of MDRO isolation. Thus, it is imperative to improve and follow hospital protocols to prevent healthcare-associated infections.
Collapse
Affiliation(s)
- Emanuele Amodio
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Stefano Pizzo
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Giuseppe Vella
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy.
| | - Valerio De Francisci
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Salvatore Antonino Distefano
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Eliana Giambelluca
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Domenico Graceffa
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Maria Gabriella Verso
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Ettore Piro
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Mario Giuffrè
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Giovanni Maurizio Giammanco
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Giuseppe Calamusa
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| |
Collapse
|
6
|
Lissajoux A, Denis B, Gault E, Pépin M, Herr M, Duran C, Teillet L, Lechowski L, Dinh A. Real-life impact of respiratory panel PCR assay on antibiotic prescription in geriatric acute care in the pre-COVID-19 era. Infect Dis Now 2023; 53:104737. [PMID: 37331699 PMCID: PMC10275648 DOI: 10.1016/j.idnow.2023.104737] [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: 04/10/2023] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES In this era of bacterial resistance, avoiding inappropriate use of antibiotic treatments is of major importance. Respiratory tract infections are frequent among older patients, and differentiating viral from bacterial infections is a challenge. The aim of our study was to evaluate the impact of recently available respiratory PCR testing on antimicrobial prescription in geriatric acute care. METHODS We performed a retrospective study, including all hospitalized geriatric patients who had had multiplex respiratory PCR testing prescribed from 1st October 2018 to 30th September 2019. The PCR test comprised a respiratory viral panel (RVP) and a respiratory bacterial panel (RBP). PCR testing could be prescribed at any time during hospitalization by geriatricians. Our primary endpoint was antibiotic prescription after viral multiplex PCR testing results. RESULTS All in all, 193 patients were included, 88 (45.6%) of whom had positive RVP, while none had positive RBP. Patients with positive RVP had significantly fewer antibiotic prescriptions following test results than patients with negative RVP (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.22-0.77; p = 0.004). Among positive-RVP patients, factors associated with antibiotic continuation were presence of radiological infiltrate (OR 12.02, 95%CI 3.07-30.29), and detected Respiratory Syncytial Virus (OR 7.54, 95%CI 1.74-32.65). That said, discontinuation of antibiotic treatment seems safe. CONCLUSION In this population, the impact of viral detection by respiratory multiplex PCR on antibiotic therapy was low. It could be optimized by means of clearly formulated local guidelines, qualified staff and specific training by infectious disease specialists. Cost-effectiveness studies are necessary.
Collapse
Affiliation(s)
- Agathe Lissajoux
- Geriatric Unit, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Bertrand Denis
- Geriatric Unit, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Elyanne Gault
- Université de Versailles Saint-Quentin-en-Yvelines, Université de Paris Saclay, INSERM U1173, APHP, Ambroise Paré Hospital, Department of Microbiology, Boulogne-Billancourt, France
| | - Marion Pépin
- Acute Geriatric Unit, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Marie Herr
- Epidemiology and Public Health Department, AP-HP Université Paris-Saclay, Raymond-Poincaré Hospital, Garches 92380, France
| | - Clara Duran
- Infectious Disease Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Laurent Teillet
- Acute Geriatric Unit, Ambroise-Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Laurent Lechowski
- Geriatric Unit, Sainte-Périne Hospital, AP-HP Paris Saclay University, Paris, France
| | - Aurélien Dinh
- Infectious Disease Department, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France.
| |
Collapse
|
7
|
Lynch JP, Zhanel GG. Escalation of antimicrobial resistance among MRSA part 1: focus on global spread. Expert Rev Anti Infect Ther 2023; 21:99-113. [PMID: 36470275 DOI: 10.1080/14787210.2023.2154653] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Staphylococcus aureus produce numerous virulence factors that influence tissue invasion, cytotoxicity, membrane damage, and intracellular persistence allowing them to be very common human pathogens. S. aureus isolates exhibit considerable diversity though specific genotypes have been associated with antimicrobial resistance (AMR) and toxin gene profiles. MRSA is an important pathogen causing both community-acquired (CA) and healthcare-acquired (HCA) infections. Importantly, over the past several decades, both HCA-MRSA and CA-MRSA have spread all over the globe. Even more concerning is that CA-MRSA clones have disseminated into hospitals and HCA-MRSA have entered the community. Factors that enhance spread of MRSA include: poor antimicrobial stewardship and inadequate infection control. The emergence and spread of multidrug resistant (MDR) MRSA has limited therapeutic options. AREAS COVERED The authors discuss the escalation of MRSA, both HCA-MRSA and CA-MRSA across the globe. A literature search of MRSA was performed via PubMed (up to September 2022), using the key words: antimicrobial resistance; β-lactams; community-associated MRSA; epidemiology; infection; multidrug resistance; Staphylococcus aureus. EXPERT OPINION Over the past several decades, MRSA has spread all over the globe. We encourage the judicious use of antimicrobials in accordance with antimicrobial stewardship programs along with infection control measures to minimize the spread of MRSA.
Collapse
Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at Ucla, Los Angeles, CA, USA
| | - George G Zhanel
- Professor-Department of Medical Microbiology and Infectious Diseases, Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|