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Al Bshabshe A, Hamid ME, Salem E, Abdelrahim IM, Assiry M, Alasmari A, Joseph M, Alhammdi Y. The extent of carbapenem-resistant encoding genes in Klebsiella pneumoniae from COVID-19 and non-COVID-19 patients in a tertiary care center, Saudi Arabia. Braz J Med Biol Res 2025; 58:e14066. [PMID: 40136226 DOI: 10.1590/1414-431x2025e14066] [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: 04/07/2024] [Accepted: 02/08/2025] [Indexed: 03/27/2025] Open
Abstract
Rapid dissemination of Klebsiella pneumoniae carbapenemase (KPC) is a leading cause of treatment failure, significantly increasing morbidity and mortality rates among inpatients, particularly in the intensive care unit (ICU). This study aimed to detect the occurrence of carbapenemase- and carbapenem-resistant-encoding genes in K. pneumoniae isolates from COVID-19 positive and negative patients, and to assess their impact on patient outcomes. A prospective analysis was conducted at a tertiary care hospital in Saudi Arabia, collecting 97 carbapenem-resistant K. pneumoniae (CRKP) isolates from patients with COVID-19 during 2020-2021. Isolates were obtained from various clinical specimens. Antimicrobial susceptibility assays were performed using the Automated Vitek-2 system, and data were analyzed using IBM SPSS Statistics. The predominant carbapenemases identified were Oxacillinase-48 (OXA-48), followed by KPC and New Delhi metallo-β-lactamase (NDM), with Imipenemase (IMP) and Verona integron-encoded metallo-β-lactamase (VIM) being the least prevalent. COVID-19 did not significantly affect the distribution of these genes (P>0.05); however, COVID-19 status and age over 60 years significantly impacted the outcomes of CRKP patients. Other factors such as gender, total ICU or ward stay, and comorbidities did not significantly affect CRKP infection outcomes. The most common carbapenem-resistant genes identified were blaKPC, blaNDM, and blaOXA-48; however, they were not significantly associated with increased mortality.
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Affiliation(s)
- A Al Bshabshe
- Department of Medicine/Adult Critical Care, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - M E Hamid
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - E Salem
- Department of Adult Critical Care, King Khalid University Medical City, Abha, Saudi Arabia
| | - I M Abdelrahim
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - M Assiry
- Department of Microbiology, Aseer Central Hospital, Abha, Saudi Arabia
| | - A Alasmari
- Department of Microbiology, Aseer Central Hospital, Abha, Saudi Arabia
| | - M Joseph
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Y Alhammdi
- Department of Microbiology, Aseer Central Hospital, Abha, Saudi Arabia
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Baum JHJ, Dörre A, Reichert F, Noll I, Feig M, Eckmanns T, Sandfort M, Haller S. Changes in incidence and epidemiology of antimicrobial resistant pathogens before and during the COVID-19 pandemic in Germany, 2015-2022. BMC Microbiol 2025; 25:51. [PMID: 39875841 PMCID: PMC11773696 DOI: 10.1186/s12866-024-03723-5] [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: 08/29/2024] [Accepted: 12/20/2024] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND Carbapenem-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are among WHO's priority pathogens with antimicrobial resistance (AMR). Studies suggest potential impacts of the COVID-19-pandemic on AMR. We described changes in AMR incidence and epidemiology in Germany during the COVID-19-pandemic. METHODS We used two independent datasets, statutory surveillance and laboratory-based Antibiotic Resistance Surveillance (ARS). We included statutory notifications of infections/colonisations of carbapenem-resistant Acinetobacter spp., Klebsiella pneumoniae, Escherichia coli (CRA/CRKP/CREC) and invasive MRSA. Using Poisson/negative binomial regression and assuming continued pre-pandemic (2015/2017-2020) trends, we projected hypothetical notifications as if the pandemic had not occurred. We quantified annual changes during the pandemic period (2020-2022) by comparing to observed notifications. Additional models considered inpatient reductions, seasonality, infections only, or resistant isolates from ARS. RESULTS CRA notified cases were reduced by -30% (95%CI -39%|-20%) in 2020, -23% (-36%|-8%) in 2021, but + 32% (+ 6%|+64%) higher in 2022 relative to hypothetical pre-pandemic projections. Changes were - 35%/-31%/+6% for CRKP, -40%/-61%/-48% for CREC and - 33%/-25%/-20% for MRSA. Statutory-models accounting for fewer inpatients, seasonality and infections only showed similar trends, as did ARS-models for resistant isolates and infections. International mobility for CRA, CRKP and CREC decreased in 2020-2021, then increased in 2022. CONCLUSIONS We observed significant reductions of AMR notifications and infections during 2020-2021, also when accounting for fewer inpatients. We conclude a genuine reduction of AMR spread occurred during the pandemic. Factors like fewer hospitalisations and reduced international mobility contributed. Rising international mobility may partly explain increases for CRA, CRKP and CREC in 2022. A solid understanding of AMR trends improves infection prevention and control.
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Affiliation(s)
- Jonathan H J Baum
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Ines Noll
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Marcel Feig
- Department of Method Development, Research Infrastructure and Information Technology, Robert Koch Institute (RKI), Berlin, Germany
| | - Tim Eckmanns
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Mirco Sandfort
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
| | - Sebastian Haller
- Department of Infectious Disease Epidemiology, Robert Koch Institute (RKI), Berlin, Germany.
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Kee YK, Park HC, Yoon SJ, Yu S, Ko E, Cho AJ, Kim DH, Kim J, Lee YK. Effectiveness of regdanvimab on mortality in COVID-19 infected patients on hemodialysis. Kidney Res Clin Pract 2024; 43:111-121. [PMID: 38268125 PMCID: PMC10846986 DOI: 10.23876/j.krcp.23.137] [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: 05/23/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Although several therapeutic agents have been evaluated for the treatment of coronavirus disease 2019 (COVID-19), there are lack of effective and proven treatments for end-stage renal disease (ESRD). The present study aims to evaluate the effectiveness of regdanvimab on mortality in COVID-19-infected patients on hemodialysis (HD). METHODS We conducted an observational retrospective study in 230 COVID-19-infected patients on HD, of whom 77 (33.5%) were administered regdanvimab alone or in combination with dexamethasone or remdesivir during hospitalization (regdanvimab group) and 153 patients (66.5%) were not (no regdanvimab group). The primary outcome was in-hospital mortality. We compared mortality rates according to the use of regdanvimab and investigated the factors associated with mortality. RESULTS Fifty-nine deaths occurred during hospitalization, 49 in the no regdanvimab group (32.0%) and 10 in the regdanvimab group (13.0%), and the mortality rate was significantly higher in the no regdanvimab group than that in the regdanvimab group (p = 0.001). Multivariate Cox regression analysis showed that malignancy (p = 0.001), SPO2 of <95% at admission (p = 0.003), and administration of antibiotics and regdanvimab (p = 0.007 and p = 0.002, respectively) were significantly associated factors with mortality. CONCLUSION Regdanvimab administration is beneficial in improving prognosis in hospitalized COVID-19 patients on HD. Considering the vulnerability to infection and high mortality of ESRD patients, regdanvimab may be considered as a therapeutic option in COVID-19 patients on HD.
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Affiliation(s)
- Youn Kyung Kee
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hayne Cho Park
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Su Jin Yoon
- Department of Internal Medicine, Good Samaritan Bagae Hospital, Pyeongtaek, Republic of Korea
| | - Sungbong Yu
- Department of General Surgery, Good Samaritan Bagae Hospital, Pyeongtaek, Republic of Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Republic of Korea
| | - AJin Cho
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jinseog Kim
- Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Republic of Korea
| | - Young-Ki Lee
- Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
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De La Cadena E, Pallares CJ, García-Betancur JC, Porras JA, Villegas MV. Update of antimicrobial resistance in level III and IV health institutions in Colombia between January 2018 and December 2021. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:457-473. [PMID: 38109138 PMCID: PMC10826464 DOI: 10.7705/biomedica.7065] [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: 06/01/2023] [Accepted: 10/10/2023] [Indexed: 12/19/2023]
Abstract
Introduction Antimicrobial resistance surveillance is a fundamental tool for the development, improvement, and adjustment of antimicrobial stewardship programs, therapeutic guidelines, and universal precautions to limit the cross-transmission of resistant bacteria between patients. Since the beginning of 2020, the SARS-CoV-2 pandemic profoundly challenged the health system and, according to some reports, increased the rates of antimicrobial resistance. Objective To describe the behavior of antimicrobial resistance of the most frequent bacterial pathogens in twenty Colombian hospitals from January 2018 to December 2021. Materials and methods We conducted a descriptive study based on the microbiological information recorded from January 2018 to December 2021 in twenty levels III and IV health institutions in twelve Colombian cities. We identified the species of the ten most frequent bacteria along with their resistance profile to the antibiotic markers after analyzing the data through WHONET. Results We found no statistically significant changes in most pathogens’ resistance profiles from January 2018 to December 2021. Only Pseudomonas aeruginosa had a statistically significant increase in its resistance profile, particularly to piperacillin/tazobactam and carbapenems. Conclusions The changes in antimicrobial resistance in these four years were not statistically significant except for P. aeruginosa to piperacillin/tazobactam and carbapenems.
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Affiliation(s)
- Elsa De La Cadena
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C., Colombia.
| | - Christian José Pallares
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C., Colombia; Comité de Infecciones y Vigilancia Epidemiológica, Clínica Imbanaco, Grupo Quirónsalud, Cali, Colombia.
| | - Juan Carlos García-Betancur
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C..
| | - Jessica A Porras
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C..
| | - María Virginia Villegas
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria, Vicerrectoría de Investigaciones, Universidad El Bosque, Bogotá, D.C., Colombia; Comité de Infecciones y Vigilancia Epidemiológica, Clínica Imbanaco, Grupo Quirónsalud, Cali, Colombia.
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Hurtado IC, Valencia S, Pinzon EM, Lesmes MC, Sanchez M, Rodriguez J, Ochoa B, Shewade HD, Edwards JK, Hann K, Khogali M. Antibiotic resistance and consumption before and during the COVID-19 pandemic in Valle del Cauca, Colombia. Rev Panam Salud Publica 2023; 47:e10. [PMID: 37082532 PMCID: PMC10105594 DOI: 10.26633/rpsp.2023.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/26/2022] [Indexed: 04/22/2023] Open
Abstract
Objective To assess changes in antibiotic resistance of eight of the World Health Organization priority bug-drug combinations and consumption of six antibiotics (ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, ciprofloxacin, vancomycin) before (March 2018 to July 2019) and during (March 2020 to July 2021) the COVID-19 pandemic in 31 hospitals in Valle del Cauca, Colombia. Methods This was a before/after study using routinely collected data. For antibiotic consumption, daily defined doses (DDD) per 100 bed-days were compared. Results There were 23 405 priority bacterial isolates with data on antibiotic resistance. The total number of isolates increased from 9 774 to 13 631 in the periods before and during the pandemic, respectively. While resistance significantly decreased for four selected bug-drug combinations (Klebsiella pneumoniae, extended spectrum beta lactamase [ESBL]-producing, 32% to 24%; K. pneumoniae, carbapenem-resistant, 4% to 2%; Pseudomonas aeruginosa, carbapenem-resistant, 12% to 8%; Acinetobacter baumannii, carbapenem-resistant, 23% to 9%), the level of resistance for Enterococcus faecium to vancomycin significantly increased (42% to 57%). There was no change in resistance for the remaining three combinations (Staphylococcus aureus, methicillin-resistant; Escherichia coli, ESBL-producing; E. coli, carbapenem-resistant). Consumption of all antibiotics increased. However, meropenem consumption decreased in intensive care unit settings (8.2 to 7.1 DDD per 100 bed-days). Conclusions While the consumption of antibiotics increased, a decrease in antibiotic resistance of four bug-drug combinations was observed during the pandemic. This was possibly due to an increase in community-acquired infections. Increasing resistance of E. faecium to vancomycin must be monitored. The findings of this study are essential to inform stewardship programs in hospital settings of Colombia and similar contexts elsewhere.
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Affiliation(s)
- Isabel Cristina Hurtado
- Valle del Cauca Secretariat of HealthCaliColombiaValle del Cauca Secretariat of Health, Cali, Colombia
- Universidad del ValleCaliColombiaUniversidad del Valle, Cali, Colombia
| | - Sandra Valencia
- Valle del Cauca Secretariat of HealthCaliColombiaValle del Cauca Secretariat of Health, Cali, Colombia
| | - Elisa Maria Pinzon
- Valle del Cauca Secretariat of HealthCaliColombiaValle del Cauca Secretariat of Health, Cali, Colombia
- Fundacion Universitaria San MartinCaliColombiaFundacion Universitaria San Martin, Cali, Colombia
| | - Maria Cristina Lesmes
- Valle del Cauca Secretariat of HealthCaliColombiaValle del Cauca Secretariat of Health, Cali, Colombia
| | - Mauro Sanchez
- University of BrasíliaBrasíliaBrazilUniversity of Brasília, Brasília, Brazil
| | - Jaime Rodriguez
- Universidad Pedagógica y Tecnológica de ColombiaTunjaColombiaUniversidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Brindis Ochoa
- Pan American Health OrganizationWashington, D.C.United States of AmericaPan American Health Organization, Washington, D.C., United States of America
| | - Hemant Deepak Shewade
- ICMR–National Institute of EpidemiologyChennaiIndiaICMR–National Institute of Epidemiology, Chennai, India
| | - Jeffrey K. Edwards
- University of WashingtonSeattleUnited States of AmericaUniversity of Washington, Seattle, United States of America
| | - Katrina Hann
- Sustainable Health SystemsFreetownSierra LeoneSustainable Health Systems, Freetown, Sierra Leone
| | - Mohammed Khogali
- World Health OrganizationGenevaSwitzerlandWorld Health Organization, Geneva, Switzerland
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Vâţă A, Roşu FM, Dorneanu OS, Lehaci AE, Luca Ş, Loghin II, Miftode ID, Luca CM, Miftode EG. Antibiotic Usage in the COVID-19 Intensive Care Unit of an Infectious Diseases Hospital from Nord-Eastern Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040645. [PMID: 37109601 PMCID: PMC10145934 DOI: 10.3390/medicina59040645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives. The intensive care unit (ICU), especially in an infectious disease hospital, is both an area with a high consumption of antibiotics (atb) and a "reservoir" of multidrug-resistant bacteria. We proposed the analysis of antibiotic therapy practices in such a department that treated, in conditions of a pandemic wave, patients with COVID-19 and its complications. Materials and Methods. This was a retrospective transversal study of 184 COVID-19 patients treated in the ICU of a regional infectious disease hospital of Iaşi, Romania, in a 3-month interval of 2020 and 2021. Results. All the included patients (Caucasians, 53% males, with a median age of 68 years, and a Charlton comorbidity index of 3) received at least one antibiotic during their stay in the ICU (43% also had antibiotics prior to hospital admission and 68% in the Infectious Diseases ward). Only 22.3% of the ICU patients had only one antibiotic. A total of 77.7% of them started with an association of two antibiotics, and 19.6% of them received more than three antibiotics. The most-used ones were linezolid (77.2%), imipenem (75.5%), and ceftriaxone (33.7%). The median atb duration was 9 days. No change in the number or type of atb prescription was seen in 2021 (compared to 2020). Only 9.8% of the patients had a microbiological confirmation of bacterial infection. A total of 38.3% of the tested patients had elevated procalcitonin levels at ICU admission. The overall fatality rate was 68.5%, with no significant differences between the two analyzed periods or the number of administered antibiotics. More than half (51.1%) of the patients developed oral candidiasis during their stay in the ICU, but only 5.4% had C. difficile colitis. Conclusion. Antibiotics were widely used in our ICU patients in the presence of a reduced microbiological confirmation of a bacterial co-infection, and were justified by other clinical or biological criteria.
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Affiliation(s)
- Andrei Vâţă
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Florin Manuel Roşu
- Department of Dento-Alveolar Surgery, Anesthesia, Sedation and Medical-Surgical Emergencies, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Olivia Simona Dorneanu
- Microbiology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universității Street, 700115 Iași, Romania
| | | | - Ştefana Luca
- Department of Plastic Surgery and Reconstructive Microsurgery, "St Spiridon" County Emergency Hospital, 700111 Iasi, Romania
| | - Isabela Ioana Loghin
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioana Diandra Miftode
- Department of Radiology, "St. Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Cătălina Mihaela Luca
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Egidia Gabriela Miftode
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Kabrah A, Bahwerth F, Alghamdi S, Alkhotani A, Alahmadi A, Alhuzali M, Aljerary I, Alsulami A. Antibiotics Usage and Resistance among Patients with Severe Acute Respiratory Syndrome Coronavirus 2 in the Intensive Care Unit in Makkah, Saudi Arabia. Vaccines (Basel) 2022; 10:2148. [PMID: 36560558 PMCID: PMC9784728 DOI: 10.3390/vaccines10122148] [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: 10/24/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Antibiotic resistance is a global health and development threat, especially during the Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19) pandemic. Therefore, the current study was conducted to describe antibiotic usage and resistance among patients with COVID-19 in the intensive care unit (ICU) in Makkah, Saudi Arabia. In this cross-sectional study, only patients with positive COVID-19 status (42 patients) admitted to the ICU at the King Faisal Hospital were selected using a census sampling method. The susceptibility test of bacteria was carried out according to the standard protocol. The identified strains were tested in-vitro against several antibiotics drugs. Statistical analysis was performed using SPSS version 24. A total of 42 patients were included, with a mean age of 59.35 ± 18 years. Of them, 38.1% were males, and 61.9% were females. 35.7% have blood group O +. For age and blood groups, statistically significant associations were found between males and females, with p-values = 0.037 and 0.031, respectively. A large percentage (42.7%) of the obtained samples contained Klebsiella Pneumoniae; all bacteria were multidrug-resistance bacteria. Furthermore, 76.2% of bacteria were resistant to Ampicillin, 66.7% were resistant to Ciprofloxacin, 64.3% were resistant to Levofloxacin, 57.1% were resistant to Imipenem, and 57.1% were resistant to Moxifloxacin. On the contrary, among the 40 examined antibiotics, the effective antibiotics were Daptomycin, Linezolid, Mupirocin, Synercid, Teicoplanin, Vancomycin, and Nitrofurantoin. Our study demonstrates that antibiotic resistance is highly prevalent among ICU patients with COVID-19 at the King Faisal Hospital. Additionally, all bacteria were multidrug-resistance bacteria. Therefore, this high prevalence should be seriously discussed and urgently considered.
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Affiliation(s)
- Ahmed Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Fayez Bahwerth
- Molecular Genetics Department, King Faisal Hospital, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Saad Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Alaa Alkhotani
- Diagnostic Microbiology Department, King Faisal Hospital, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Ahmed Alahmadi
- Medical Genetics Department, King Faisal Hospital, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Mashari Alhuzali
- Diagnostic Microbiology Department, King Faisal Hospital, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Ibrahim Aljerary
- Pharmaceutical Department, King Faisal Hospital, Ministry of Health, Makkah 21955, Saudi Arabia
| | - Anwar Alsulami
- Health Administration, King Faisal Hospital, Ministry of Health, Makkah 21955, Saudi Arabia
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Torumkuney D, Kozlov R, Sidorenko S, Kamble P, Lezhnina M, Galushkin A, Kundu S. Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77:i61-i69. [PMID: 36065732 PMCID: PMC9445848 DOI: 10.1093/jac/dkac218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Antimicrobial reistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. OBJECTIVES To review AMR in Russia and any initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Russia and to improve patient outcomes. METHODS National AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from both a local clinician and a local clinical microbiologist were sought to contextualize this information. CONCLUSIONS Russia launched a national strategy in 2017 to prevent the spread of AMR and the WHO reports that as of 2020-21, it is being implemented and actively monitored. Reports suggest outpatient antibiotic use of antibiotics is high and that non-prescription access and self-medication are very common. Antibiotic susceptibility studies in Russia include PeHASus, a multicentre epidemiological study focusing on susceptibilities of community-acquired respiratory pathogens and international studies such as Survey of Antibiotic Resistance (SOAR), Antimicrobial Testing Leadership and Surveillance (ATLAS) and SENTRY Antimicrobial Surveillance Program. International guidelines are used to support the development of local guidelines in Russia, and for the common CA-RTIs Russian clinicians use of several country-specific local antibiotic prescribing guidelines. A standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Russia, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Roman Kozlov
- Smolensk State Medical University (SSMU), Krupskaya Str. 28 Smolensk 214019, Russia
| | - Sergey Sidorenko
- Pediatric Research and Clinical Centre for Infectious Diseases, Professor Popov Str. 9, Russia
- North Western State Medical University named after I. I. Mechnikov, Kirochnaya Str. 41, St Petersburg 195067, Russia
| | - Praveen Kamble
- GlaxoSmithKline, 252, Dr Annie Besant Road, Worli, 400030, Mumbai, India
| | - Margarita Lezhnina
- GlaxoSmithKline Trading, Leningrad’s prospect, 37A, bld. 4, Arcus III, 125167 Moscow, Russia
| | - Aleksandr Galushkin
- GlaxoSmithKline Trading, Leningrad’s prospect, 37A, bld. 4, Arcus III, 125167 Moscow, Russia
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Alali WQ, Abdo NM, AlFouzan W, Dhar R. Antimicrobial resistance pattern in clinical Escherichia coli and Pseudomonas aeruginosa isolates obtained from a secondary-care hospital prior to and during the COVID-19 pandemic in Kuwait. Germs 2022; 12:372-383. [PMID: 37680673 PMCID: PMC10482471 DOI: 10.18683/germs.2022.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/16/2022] [Accepted: 08/23/2022] [Indexed: 09/09/2023]
Abstract
Introduction The study objective was to compare the prevalence of antimicrobial resistance (AMR) in clinical Escherichia coli and Pseudomonas aeruginosa isolates obtained from a secondary-care hospital prior to and during the COVID-19 pandemic in Kuwait. Methods A retrospective descriptive study was conducted based on AMR profiles of clinical Escherichia coli and Pseudomonas aeruginosa isolates. The AMR data represented isolates from five specimen types (body fluids; blood; respiratory; wound, bone, or other tissues; and urine) of patients admitted to four wards (surgical, medical, pediatric, and maternal-postnatal). Tested isolates between January 2019 and February 2020 represented the pre-COVID-19 pandemic period in Kuwait, whereas those from February 2020 until April 2021 represented the 'during COVID-19' period. Results A total of 1,303 isolates (57.2% E. coli and 42.8% P. aeruginosa) were analyzed. For ceftazidime, ertapenem and meropenem, the prevalence of AMR in E. coli was significantly (p<0.05) lower in pre-COVID-19 wards compared to that during COVID-19, whereas for other antibiotics (i.e., cefepime, gentamicin, and trimethoprim/sulfamethoxazole), the prevalence of AMR in pre-COVID-19 was significantly higher than that during COVID-19. The prevalence of AMR to gentamicin in P. aeruginosa isolates from non-COVID-19 wards (52.8%) was significantly higher (p<0.001) than that from COVID-19 wards (35.0%) and from the pre-COVID-19 period (32.9%). The multidrug-resistance (MDR) prevalence was 37.4% for E. coli and 32.1% for P. aeruginosa isolates. The odds of MDR in E. coli isolates from the COVID-19 medical wards were significantly lower (OR=0.27, [95%CI: 0.09-0.80], p=0.018) compared to the pre-COVID-19 wards. The odds of MDR E. coli and P. aeruginosa isolates by COVID-19 status stratified by specimen type were not different (p>0.05). Conclusions No major differences in AMR in E. coli and P. aeruginosa prevalence by specimen type and wards prior to and during the COVID-19 pandemic was observed at this hospital. The high reported MDR prevalence calls for better infection control and prevention.
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Affiliation(s)
- Walid Q. Alali
- DVM, MS, PhD, Department of Epidemiology & Biostatistics, Faculty of Public Health, Kuwait University, Sabah AlSalem Education City, 12 Street, Andalous, postal code 65000, Kuwait
| | - Naglaa M. Abdo
- MD, PhD, Department of Infection Control, Farwaniya Hospital, Ministry of Health, Sabah Al Nasser, postal code 85000, Kuwait, and Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Shaibet an Nakareyah, Zagazig, postal code 44519, Egypt
| | - Wadha AlFouzan
- MD, PhD, Department of Microbiology, Faculty of Medicine, Kuwait University, Fourth Ring Rd, Jabriya, postal code 13060, Kuwait, and Microbiology Unit, Department of Laboratories, Farwaniya Hospital, Farwaniya, Sabah Al Nasser, postal code 85000, Kuwait
| | - Rita Dhar
- MD, Microbiology Unit, Department of Laboratories, Farwaniya Hospital, Farwaniya, Sabah Al Nasser, postal code 85000, Kuwait
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10
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Chauhan S, Gilbert D, Hughes A, Kennerley Z, Phillips C, Davies A. Impact of the COVID-19 pandemic on provision of antimicrobial stewardship education and training in UK health service sites. J Interprof Care 2022; 37:519-521. [PMID: 35895577 DOI: 10.1080/13561820.2022.2082393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The impact of the COVID-19 pandemic on antimicrobial stewardship is a cause for serious concern. There is evidence of increased antibiotic usage in many settings and fears of over-use, especially of broad-spectrum antibiotics in patients with COVID-19, raising concerns about potential impact on antimicrobial resistance globally. At the same time, the pandemic has impacted the provision of education and training throughout the health and education sectors, during a period when health services and staff were under unprecedented pressure. All-Wales Antimicrobial Resistance Educators (AWARE) is an interprofessional network of healthcare professionals whose roles include provision of antimicrobial stewardship education in National Health Service health boards across Wales. The aim of this report was to use AWARE project data to study the impact of the pandemic on the provision of antimicrobial stewardship education and training in healthcare settings in Wales in 2020, compared to 2019. Overall, the number of staff reached by education increased by 10%, despite the number of educational sessions falling by 26% and the number of hours of teaching by 43%. Rapid switch to virtual education allowed fewer, shorter, educational sessions, allowing more staff to be reached.
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Affiliation(s)
| | | | - Aled Hughes
- Pharmacy Department, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Zoe Kennerley
- Pharmacy Department, Hywel Dda University Health Board, Haverfordwest, UK
| | - Ceri Phillips
- Pharmacy Department, Aneurin Bevan University Health Board, Newport, UK
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11
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Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients in Lahore, Pakistan. Medicina (B Aires) 2022; 58:medicina58070904. [PMID: 35888623 PMCID: PMC9322062 DOI: 10.3390/medicina58070904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objective: Bacterial infections are among the major complications of many viral respiratory tract illnesses, such as influenza and coronavirus disease-2019 (COVID-19). These bacterial co-infections are associated with an increase in morbidity and mortality rates. The current observational study was conducted at a tertiary care hospital in Lahore, Pakistan among COVID-19 patients with the status of oxygen dependency to see the prevalence of bacterial co-infections and their antibiotic susceptibility patterns. Materials and Methods: A total of 1251 clinical samples were collected from already diagnosed COVID-19 patients and tested for bacterial identification (cultures) and susceptibility testing (disk diffusion and minimum inhibitory concentration) using gold standard diagnostic methods. Results: From the total collected samples, 234 were found positive for different bacterial isolates. The most common isolated bacteria were Escherichia coli (E. coli) (n = 62) and Acinetobacter baumannii (A. baumannii) (n = 47). The E. coli isolates have shown the highest resistance to amoxicillin and ampicillin, while in the case of A. baumannii, the highest resistance was noted against tetracycline. The prevalence of methicillin resistant Staphylococcus aureus (MRSA) was 14.9%, carbapenem resistant Enterobacteriaceae (CRE) was 4.5%, and vancomycin resistant Enterococcus (VRE) was 3.96%. Conclusions: The results of the current study conclude that empiric antimicrobial treatment in critically ill COVID-19 patients may be considered if properly managed within institutional or national level antibiotic stewardship programs, because it may play a protective role in the case of bacterial co-infections, especially when a patient has other AMR risk factors, such as hospital admission within the previous six months.
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12
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Lashari Y, Rochmanti M, Purba AKR, Notobroto HB, Sarassari R, Kuntaman K. The Economic Impact of Carbapenem Resistant-Non Lactose Fermenter and Enterobacteriaceae Infections on Hospital Costs in Dr. Soetomo General Academic Hospital Surabaya, Indonesia. Antibiotics (Basel) 2022; 11:694. [PMID: 35625338 PMCID: PMC9137956 DOI: 10.3390/antibiotics11050694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Carbapenem resistant-non lactose fermenter (CR-NLF) and Carbapenem resistant-Enterobacteriaceae (CR-E) bacterial infections are likely to be a global threat to people’s health. However, studies on the economic impacts according to the hospital setting are very scarce. The study aimed to explore the impact of CR-NLF (Acinetobacter baumannii = CRAB) & Pseudomonas aeruginosa = CRPA) and CR-E (Escherichia coli = CREC) & Klebsiella pneumoniae = CRKP) infections on hospital costs from a payer perspective among patients admitted to Dr.Soetomo Hospital, Surabaya, Indonesia. Methods: In the retrospective case-control study, medical records of all included patients hospitalized during 2018−2021 were reviewed for CRAB, CRPA, CREC, CRKP, and carbapenem sensitive (CSAB, CSPA, CSEC, CSKP) were collected. We retrieved the data of age, gender, clinical specimen, dates of admission, and discharge status. The outcomes of interest were hospital length of stay and hospitalization cost. Results: The cost for CR-NLFs infections was higher than carbapenem sensitive, $3026.24 versus $1299.28 (p < 0.05). There was no significant difference between CR-E against carbapenem sensitive. It showed that the highest impact of the cost was CRAB, followed by CRPA, CRKP, and CREC. The bed, antibiotics, pharmacy, and diagnostic costs of CR-NLFIs were significantly higher than CR-E. Conclusion: This study showed that the hospital cost and expenditure of CR-NLFs per patient were higher than CS. The hospital cost per patient for CR-NLF was higher than CR-E.
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Affiliation(s)
- Yasmeen Lashari
- Doctoral Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Maftuchah Rochmanti
- Division of Pharmacology, Department of Anatomy, Histology and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia; (M.R.); (A.K.R.P.)
| | - Abdul Khairul Rizki Purba
- Division of Pharmacology, Department of Anatomy, Histology and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia; (M.R.); (A.K.R.P.)
| | - Hari Basuki Notobroto
- Department of Biostatistics and Population, Faculty of Public Health, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Rosantia Sarassari
- Clinical Microbiology Specialist Program, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Kuntaman Kuntaman
- Department of Medical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya 60286, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia
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13
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Shbaklo N, Corcione S, Vicentini C, Giordano S, Fiorentino D, Bianco G, Cattel F, Cavallo R, Zotti CM, De Rosa FG. An Observational Study of MDR Hospital-Acquired Infections and Antibiotic Use during COVID-19 Pandemic: A Call for Antimicrobial Stewardship Programs. Antibiotics (Basel) 2022; 11:695. [PMID: 35625339 PMCID: PMC9138124 DOI: 10.3390/antibiotics11050695] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
The pandemic caused by the COVID-19 virus has required major adjustments to healthcare systems, especially to infection control and antimicrobial stewardship. The objective of this study was to describe the incidence of multidrug-resistant (MDR) hospital-acquired infections (HAIs) and antibiotic consumption during the three waves of COVID-19 and to compare it to the period before the outbreak at Molinette Hospital, located in the City of Health and Sciences, a 1200-bed teaching hospital with surgical, medical, and intensive care units. We demonstrated an increase in MDR infections: particularly in K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp), A. baumannii, and MRSA. Fluoroquinolone use showed a significant increasing trend in the pre-COVID period but saw a significant reduction in the COVID period. The use of fourth- and fifth-generation cephalosporins and piperacillin-tazobactam increased at the beginning of the COVID period. Our findings support the need for restoring stewardship and infection control practices, specifically source control, hygiene, and management of invasive devices. In addition, our data reveal the need for improved microbiological diagnosis to guide appropriate treatment and prompt infection control during pandemics. Despite the infection control practices in place during the COVID-19 pandemic, invasive procedures in critically ill patients and poor source control still increase the risk of HAIs caused by MDR organisms.
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Affiliation(s)
- Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy; (S.C.); (F.G.D.R.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy; (S.C.); (F.G.D.R.)
- Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy; (C.V.); (C.M.Z.)
| | - Susanna Giordano
- S.C. Farmacia Ospedaliera, A.O.U. Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (S.G.); (D.F.); (F.C.)
| | - Denise Fiorentino
- S.C. Farmacia Ospedaliera, A.O.U. Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (S.G.); (D.F.); (F.C.)
| | - Gabriele Bianco
- Microbiology and Virology Unit, Turin University, 10124 Turin, Italy; (G.B.); (R.C.)
| | - Francesco Cattel
- S.C. Farmacia Ospedaliera, A.O.U. Città Della Salute e Della Scienza di Torino, 10126 Turin, Italy; (S.G.); (D.F.); (F.C.)
| | - Rossana Cavallo
- Microbiology and Virology Unit, Turin University, 10124 Turin, Italy; (G.B.); (R.C.)
| | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy; (C.V.); (C.M.Z.)
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy; (S.C.); (F.G.D.R.)
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14
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Avdeev S, Rachina S, Belkova Y, Kozlov R, Versporten A, Pauwels I, Goossens H, Bochanova E, Elokhina E, Portnjagina U, Reshetko O, Sychev I, Strelkova D, On Behalf Of Russian Global-Pps Project Study Group. Antimicrobial Prescribing Patterns in Patients with COVID-19 in Russian Multi-Field Hospitals in 2021: Results of the Global-PPS Project. Trop Med Infect Dis 2022; 7:75. [PMID: 35622702 PMCID: PMC9147532 DOI: 10.3390/tropicalmed7050075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic is a global public health challenge with understudied effects on antimicrobial usage. We aimed to analyze antimicrobial prescribing patterns in COVID-19 patients in Russian multi-field hospitals by means of the Global-PPS Project developed by the University of Antwerp. Out of 999 patients in COVID-19 wards in six hospitals surveyed in 2021, 51.3% received antimicrobials (79% in intensive care, 47.5% in medical wards). Systemic antivirals and antibiotics were prescribed to 31% and 35.1% of patients, respectively, and a combination of both to 14.1% of patients. The top antivirals administered were favipiravir (65%), remdesivir (19.2%), and umifenovir (15.8%); the top antibiotics were ceftriaxone (29.7%), levofloxacin (18%), and cefoperazone/sulbactam (10.4%). The vast majority of antibiotics was prescribed for treatment of pneumonia or COVID-19 infection (59.3% and 25.1%, respectively). Treatment was based on biomarker data in 42.7% of patients but was targeted only in 29.6% (6.7% for antibiotics). The rate of non-compliance with guidelines reached 16.6%. Antimicrobial prescribing patterns varied considerably in COVID-19 wards in Russian hospitals with groundlessly high rates of systemic antibiotics. Antimicrobial usage surveillance and stewardship should be applied to inpatient care during the COVID-19 pandemic.
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Affiliation(s)
- Sergey Avdeev
- First Moscow State Medical University, 119435 Moscow, Russia
| | | | - Yuliya Belkova
- Smolensk State Medical University, 214019 Smolensk, Russia
| | - Roman Kozlov
- Smolensk State Medical University, 214019 Smolensk, Russia
| | - Ann Versporten
- Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Antwerp, Belgium
| | - Ines Pauwels
- Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Antwerp, Belgium
| | - Herman Goossens
- Vaccine and Infectious Disease Institute, University of Antwerp, 2610 Antwerp, Belgium
| | - Elena Bochanova
- Krasnoyarsk State Medical University n.a. Professor V. F. Voyno-Yasenetsky, 660022 Krasnoyarsk, Russia
| | | | | | - Olga Reshetko
- Saratov State Medical University n.a. V. I. Razumovsky, 410000 Saratov, Russia
| | - Igor Sychev
- City Clinical Hospital n.a. S.S. Yudin, 117198 Moscow, Russia
| | - Darya Strelkova
- First Moscow State Medical University, 119435 Moscow, Russia
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15
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Kariyawasam RM, Julien DA, Jelinski DC, Larose SL, Rennert-May E, Conly JM, Dingle TC, Chen JZ, Tyrrell GJ, Ronksley PE, Barkema HW. Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019-June 2021). Antimicrob Resist Infect Control 2022; 11:45. [PMID: 35255988 PMCID: PMC8899460 DOI: 10.1186/s13756-022-01085-z] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pneumonia from SARS-CoV-2 is difficult to distinguish from other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed to patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR). OBJECTIVES We conducted a systematic review and meta-analysis during the first 18 months of the pandemic to quantify the prevalence and types of resistant co-infecting organisms in patients with COVID-19 and explore differences across hospital and geographic settings. METHODS We searched MEDLINE, Embase, Web of Science (BioSIS), and Scopus from November 1, 2019 to May 28, 2021 to identify relevant articles pertaining to resistant co-infections in patients with laboratory confirmed SARS-CoV-2. Patient- and study-level analyses were conducted. We calculated pooled prevalence estimates of co-infection with resistant bacterial or fungal organisms using random effects models. Stratified meta-analysis by hospital and geographic setting was also performed to elucidate any differences. RESULTS Of 1331 articles identified, 38 met inclusion criteria. A total of 1959 unique isolates were identified with 29% (569) resistant organisms identified. Co-infection with resistant bacterial or fungal organisms ranged from 0.2 to 100% among included studies. Pooled prevalence of co-infection with resistant bacterial and fungal organisms was 24% (95% CI 8-40%; n = 25 studies: I2 = 99%) and 0.3% (95% CI 0.1-0.6%; n = 8 studies: I2 = 78%), respectively. Among multi-drug resistant organisms, methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and multi-drug resistant Candida auris were most commonly reported. Stratified analyses found higher proportions of AMR outside of Europe and in ICU settings, though these results were not statistically significant. Patient-level analysis demonstrated > 50% (n = 58) mortality, whereby all but 6 patients were infected with a resistant organism. CONCLUSIONS During the first 18 months of the pandemic, AMR prevalence was high in COVID-19 patients and varied by hospital and geography although there was substantial heterogeneity. Given the variation in patient populations within these studies, clinical settings, practice patterns, and definitions of AMR, further research is warranted to quantify AMR in COVID-19 patients to improve surveillance programs, infection prevention and control practices and antimicrobial stewardship programs globally.
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Affiliation(s)
- Ruwandi M Kariyawasam
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Danielle A Julien
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Dana C Jelinski
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Samantha L Larose
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
| | - Elissa Rennert-May
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Departments of Medicine, Microbiology, Immunology and Infectious Diseases, and Community Health Sciences, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada
| | - John M Conly
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Departments of Medicine, Pathology and Laboratory Medicine, Microbiology, Immunology and Infectious Diseases, O'Brien Institute for Public Health, Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Tanis C Dingle
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Justin Z Chen
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gregory J Tyrrell
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Division of Diagnostic and Applied Microbiology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Alberta Precision Laboratories - Public Health Laboratory (ProvLab), Edmonton, AB, Canada
| | - Paul E Ronksley
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada
- Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Herman W Barkema
- Antimicrobial Resistance - One Health Consortium, Calgary, AB, Canada.
- Departments of Production Animal Health and Community Health Sciences,, One Health at UCalgary, University of Calgary, 3330 Hospital Drive NW, Calgary, T2N 4N1, Canada.
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16
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Karoli NA, Rebrov A. Some issues of safety of antimicrobial therapy in COVID-19 patients. CLINICAL MICROBIOLOGY AND ANTIMICROBIAL CHEMOTHERAPY 2022. [DOI: 10.36488/cmac.2022.3.226-235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Currently, there is a lack of evidence for empiric use of antimicrobial agents in most patients with COVID-19 in outpatient and hospital settings as the overall proportion of secondary bacterial infections in COVID-19 is quite low. This literature review summarizes data on changes in antimicrobial resistance over the course of COVID-19 pandemic, especially in nosocomial ESKAPE pathogens. The other significant consequences of excessive and unnecessary administration of antibiotics to COVID-19 patients including risk of Clostridioides difficile infection and adverse effects of antimicrobial agents are also discussed.
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Affiliation(s)
- Nina A. Karoli
- Saratov State Medical University named after V.I. Razumovsky (Saratov, Russia)
| | - A.P. Rebrov
- Saratov State Medical University named after V.I. Razumovsky (Saratov, Russia)
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17
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Gutema G, Homa G. Cropping Up Crisis at the Nexus Between COVID-19 and Antimicrobial Resistance (AMR) in Africa: A Scoping Review and Synthesis of Early Evidence. Cureus 2022; 14:e21035. [PMID: 35155003 PMCID: PMC8820498 DOI: 10.7759/cureus.21035] [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] [Accepted: 01/08/2022] [Indexed: 11/16/2022] Open
Abstract
In this study, we aim to synthesize some evidence on the impacts that coronavirus disease 2019 (COVID-19) is having on the epidemiology of antimicrobial resistance (AMR) in Africa since it was declared a global pandemic by the WHO in March 2020. A scoping review was undertaken by collecting and curating relevant resources from peer-reviewed articles and also from the gray literature. Mixed approaches of extracting data (qualitative and quantitative) were employed in synthesizing evidence, as suggested by the Health Evidence Network. A model constructed based on the synthesis of early evidence available on the effects of factors linked to COVID-19 in impacting the evolution of AMR in Africa predicted that, in cumulative terms, those factors favoring the evolution of AMR outpace those disfavoring it by no less than three folds. COVID-19 is likely fueling the evolution of AMR almost unhindered in Africa. Due to the recognition of this crisis, concerted efforts for resource mobilization and global cooperation are needed to tackle it.
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Affiliation(s)
- Girma Gutema
- Pharmacology, Rift Valley University, Adama, ETH
- School of Pharmacy, University of Oslo, Oslo, NOR
| | - Gadissa Homa
- Pharmacology, Hayat Medical College, Addis Ababa, ETH
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18
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Wardoyo EH, Suardana IW, Yasa IWPS, Sukrama IDM. Antibiotics susceptibility of Escherichia coli isolates from clinical specimens before and during COVID-19 pandemic. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:156-160. [PMID: 34540149 PMCID: PMC8408029 DOI: 10.18502/ijm.v13i2.5974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives Escherichia coli is a Gram-negative organism causing mild to severe infections, with a wide spectrum range of organs involved. The study aimed to describe antibiotics susceptibility of E. coli from clinical specimens from October 11, 2019 to September 11, 2020. Materials and Methods Study was conducted retrospectively in a private microbiology laboratory in Mataram Indonesia. Period of study divided as two groups after WHO declared COVID-19 as pandemic by March 11, 2020; group A including the specimen related to September 2019 to March 11th 2020 and group B including the specimens related to March 11th 2020 to September 2020. All clinical specimens were subjected to identify E. coli isolates and their antibiotics susceptibility using WHO-NET 5.6 version. Results Totally, 148 E. coli isolates were found in group A and 62 isolates in group B. Prevalence of extended-spectrum beta lactamase (ESBL)- producing E. coli in group A was 50% and in group B was 20.9% with significantly difference (p<0.05). There was an increase in susceptibility to 10/16 antibiotics; where 3 antibiotics ofloxacin, aztreonam, and fosfomycin were significant (p<0.05). There was a significant decrease in susceptibility to the antibiotics piperacillin (p=0.012), amoxicillin (p=0.002), cefadroxil (p=0.036) and ampicillin (p=0.036). Type of infections between two groups: musculoskeletal infections, pneumonia, urinary tract infections and sepsis were not significant. Conclusion Reduced number of E. coli isolates between two groups with decrease of ESBL-producing E. coli contribute in dynamics of antibiotics susceptibility. The longer period of analysis is needed to be done, due to the ongoing COVID-19 pandemic.
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Affiliation(s)
- Eustachius Hagni Wardoyo
- Department of Microbiology, School of Medicine, Universitas Mataram, Mataram, Indonesia.,Department of Doctoral Studies, School of Medicine, Universitas Udayana, Bali, Indonesia
| | - I Wayan Suardana
- Department of Microbiology, School of Veterinary Medicine, Universitas Udayana, Bali, Indonesia
| | | | - I Dewa Made Sukrama
- Department of Microbiology, School of Medicine, Universitas Udayana, Bali, Indonesia
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Calderon M, Li A, Bazo-Alvarez JC, Dennis J, Baker KF, Schim van der Loeff I, Hanrath AT, Capstick R, Payne BAI, Weiand D, Hunter E, Schwab U. Evaluation of procalcitonin-guided antimicrobial stewardship in patients admitted to hospital with COVID-19 pneumonia. JAC Antimicrob Resist 2021; 3:dlab133. [PMID: 34430872 PMCID: PMC8378277 DOI: 10.1093/jacamr/dlab133] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022] Open
Abstract
Background Procalcitonin is a biomarker that may be able to identify patients with COVID-19 pneumonia who do not require antimicrobials for bacterial respiratory tract co-infections. Objectives To evaluate the safety and effectiveness of a procalcitonin-guided algorithm in rationalizing empirical antimicrobial prescriptions in non-critically ill patients with COVID-19 pneumonia. Methods Retrospective, single-site, cohort study in adults hospitalized with confirmed or suspected COVID-19 pneumonia and receiving empirical antimicrobials for potential bacterial respiratory tract co-infection. Regression models were used to compare the following outcomes in patients with and without procalcitonin testing within 72 h of starting antimicrobials: antimicrobial consumption (DDD); antimicrobial duration; a composite safety outcome of death, admission to HDU/ICU or readmission to hospital within 30 days; and length of admission. Procalcitonin levels of ≤0.25 ng/L were interpreted as negatively predictive of bacterial co-infection. Effects were expressed as ratios of means (ROM) or prevalence ratios (PR) accordingly. Results 259 patients were included in the final analysis. Antimicrobial use was lower in patients who had procalcitonin measured within 72 h of starting antimicrobials: mean antimicrobial duration 4.4 versus 5.4 days, adjusted ROM 0.7 (95% CI 0.6-0.9); mean antimicrobial consumption 6.8 versus 8.4 DDD, adjusted ROM 0.7 (95% CI 0.6-0.8). Both groups had similar composite safety outcomes (adjusted PR 0.9; 95% CI 0.6-1.3) and lengths of admission (adjusted ROM 1.3; 95% CI 0.9-1.6). Conclusions A procalcitonin-guided algorithm may allow for the safe reduction of antimicrobial usage in hospitalized non-critically ill patients with COVID-19 pneumonia.
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Affiliation(s)
- Maria Calderon
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ang Li
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Juan Carlos Bazo-Alvarez
- Research Department of Primary Care & Population Health, University College London, London, UK.,Escuela de Medicina, Universidad Cesar Vallejo, Trujillo, Peru
| | - Jonathan Dennis
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Kenneth F Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ina Schim van der Loeff
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Aidan T Hanrath
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Richard Capstick
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Brendan A I Payne
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Weiand
- Microbiology Department, Integrated Laboratory Medicine Directorate, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ewan Hunter
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ulrich Schwab
- Department of Infection and Tropical Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Palagin I, Rachina S, Sukhorukova M, Nizhegorodtseva I, Portnyagina U, Gordeeva S, Burasova E, Bagin V, Domanskaya O, Nathwani D, Kozlov R. Current Antimicrobial Stewardship Practice and Education in Russian Hospitals: Results of a Multicenter Survey. Antibiotics (Basel) 2021; 10:antibiotics10080892. [PMID: 34438942 PMCID: PMC8388790 DOI: 10.3390/antibiotics10080892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Proper antibiotic usage education and training of medical students and healthcare professionals is the cornerstone to implement antimicrobial stewardship (AMS) programs worldwide. We conducted this voluntary and anonymous survey on current and preferred educational provision of AMS in Russia. Among 1358 polled respondents from six participating Centers located in geographically remote Federal Districts of Russia, the majority were nurses (52.8%) and doctors (42.0%). Results of the survey demonstrated better coverage of education in AMS on an undergraduate level (57.1%). More than half of respondents in total (52.4%) stated they had not received any postgraduate training. Those 38.4% respondents who received postgraduate teaching in AMS stated that it had been provided substantially by an employing hospital (28.4%) or by a medical university/college (22.3%). According to the conducted survey, the methods of education in AMS in Russian Federation mainly include traditional face-to-face lectures, presentations and provision with clinical guidelines, recommendations and printed materials. The involvement of e-learning and web-based online approaches was lacking. The survey allowed us the identify the key problems associated with training of healthcare workers in this field, in particular the varying availability of under- and postgraduate education in different parts of Russia.
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Affiliation(s)
- Ivan Palagin
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, 214019 Smolensk, Russia; (M.S.); (R.K.)
- Correspondence: or
| | - Svetlana Rachina
- Sechenov First Moscow State Medical University, 119435 Moscow, Russia;
| | - Marina Sukhorukova
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, 214019 Smolensk, Russia; (M.S.); (R.K.)
| | - Irina Nizhegorodtseva
- State Budgetary Healthcare Institution “Regional Clinical Hospital #2”, The Ministry of Health of Krasnodar Region, 350012 Krasnodar, Russia;
| | - Ulyana Portnyagina
- State Budgetary Institution of the Republic of Sakha (Yakutia) “Regional Hospital #2 Emergency Medical Center”, 677005 Yakutsk, Russia;
| | - Svetlana Gordeeva
- State Regional Budgetary Healthcare Institution “Murmansk Regional Clinical Hospital n.a. P.A. Bayandin”, 183032 Murmansk, Russia;
| | - Elena Burasova
- State Autonomous Healthcare Institution “Republican Clinical Hospital n.a. N.A. Semashko”, The Ministry of Health of the Republic of Buryatia, 670031 Ulan-Ude, Russia;
| | - Vladimir Bagin
- Medical Association “New Hospital”, 620109 Ekaterinburg, Russia;
| | - Olga Domanskaya
- Kuzbas Children’s Clinical Hospital n.a. Professor Y.E. Malakhovskiy, 654063 Novokuznetsk, Russia;
| | - Dilip Nathwani
- Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK;
| | - Roman Kozlov
- Institute of Antimicrobial Chemotherapy, Smolensk State Medical University, 214019 Smolensk, Russia; (M.S.); (R.K.)
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21
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Alied M. Antimicrobial resistance, COVID-19 and self-medication in Syria: a potential boost for an already escalating problem. JAC Antimicrob Resist 2021; 3:dlab100. [PMID: 34286274 PMCID: PMC8286850 DOI: 10.1093/jacamr/dlab100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Marcel Alied
- Faculty of Pharmacy, University of Aleppo, Aleppo, Syria
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22
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Vidyarthi AJ, Das A, Chaudhry R. Antimicrobial resistance and COVID-19 syndemic: Impact on public health. Drug Discov Ther 2021; 15:124-129. [PMID: 34234060 DOI: 10.5582/ddt.2021.01052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The COVID -19 pandemic has had a catastrophic impact on the global economy and the healthcare industry. Unfortunately, the scientific community still hasn't discovered a definite cure for this virus. Also, owing to the unscrupulous use of antibiotics in wake of the current situation, another ongoing pandemic of antimicrobial resistance (AMR) has been entirely eclipsed. However, increased compliance to infection control measures like hand hygiene (both at hospital and community level), and restricted travel might be favorable. It is evident that the AMR strategies will be impacted disproportionately varying with the respective policies followed by the countries and hospitals to deal with the pandemic. The vaccination drive initiated globally has provided a glimmer of hope. In this article, the possible reciprocity between the two contemporaneous pandemics has been addressed. The world needs to be vigilant to punctuate the symphony between these lethal threats to global health. The restraint to combat against AMR will be boosted as our discernment of the problem also changes with the epidemiological interplay becoming more apparent in near future.
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Affiliation(s)
- Ashima Jain Vidyarthi
- Department of Microbiology, All India Institute of Medical Sciences, New Delh, India
| | - Arghya Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delh, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delh, India
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23
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Nguyen LP, Park CS, Pinto NA, Lee H, Seo HS, Vu TN, Mai H, Pham AHT, Jang E, Cho YL, Goglin K, Nguyen K, White R, D’Souza R, Fouts DE, Yong D. In Vitro Activity of a Novel Siderophore-Cephalosporin LCB10-0200 (GT-1), and LCB10-0200/Avibactam, against Carbapenem-Resistant Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa Strains at a Tertiary Hospital in Korea. Pharmaceuticals (Basel) 2021; 14:370. [PMID: 33923801 PMCID: PMC8072773 DOI: 10.3390/ph14040370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
The siderophore-antibiotic conjugate LCB10-0200 (a.k.a. GT-1) has been developed to combat multidrug-resistant Gram-negative bacteria. In this study, the in vitro activity of LCB10-0200 and LCB10-0200/avibactam (AVI) has been investigated against carbapenem-resistant Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Minimal inhibitory concentrations (MICs) of LCB10-0200, LCB10-0200/AVI, aztreonam, aztreonam/AVI, ceftazidime, ceftazidime/AVI, and meropenem were measured using the agar dilution method. Whole genome sequencing was performed using Illumina and the resistome was analyzed. LCB10-0200 displayed stronger activity than the comparator drugs in meropenem-resistant E. coli and K. pneumoniae, and the addition of AVI enhanced the LCB10-0200 activity to MIC ≤ 0.12 mg/L for 90.5% of isolates. In contrast, whereas LCB10-0200 alone showed potent activity against meropenem-resistant A. baumannii and P. aeruginosa at MIC ≤ 4 mg/L for 84.3% of isolates, the combination with AVI did not improve its activity. LCB10-0200/AVI was active against CTX-M-, SHV-, CMY-, and KPC- producing E. coli and K. pneumoniae, while LCB10-0200 alone was active against ADC-, OXA-, and VIM- producing A. baumannii and P. aeruginosa. Both LCB10-0200 and LCB10-0200/AVI displayed low activity against IMP- and NDM- producing strains. LCB10-0200 alone exhibited strong activity against selected strains. The addition of AVI significantly increased LCB10-0200 activity against carbapenem-resistant E. coli, K. pneumoniae.
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Affiliation(s)
- Le Phuong Nguyen
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Chul Soon Park
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | - Naina Adren Pinto
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyunsook Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hyun Soo Seo
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | - Thao Nguyen Vu
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
| | - Hung Mai
- School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - An H. T. Pham
- UCI School of Biological Sciences, University of California, Irvine, CA 92617, USA;
| | - Eris Jang
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
| | | | | | - Kevin Nguyen
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Richard White
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Roshan D’Souza
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Derrick E. Fouts
- J. Craig Venter Institute, Rockville, MD 20850, USA; (K.N.); (R.W.); (R.D.); (D.E.F.)
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul 03722, Korea; (L.P.N.); (C.S.P.); (N.A.P.); (H.L.); (H.S.S.); (T.N.V.); (E.J.)
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul 03722, Korea
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24
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Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27:520-531. [PMID: 33418017 PMCID: PMC7785281 DOI: 10.1016/j.cmi.2020.12.018] [Citation(s) in RCA: 510] [Impact Index Per Article: 127.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
Background The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. Objective The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. Data Sources We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. Study Eligibility Criteria We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. Participants The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). Methods The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. Results We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Conclusions Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
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