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Butscheid Y, Frey PM, Pfister M, Pagani L, Kouyos RD, Scheier TC, Staiger WI, Mancini S, Brugger SD. Decline of antimicrobial resistance in Pseudomonas aeruginosa bacteraemia following the COVID-19 pandemic: a longitudinal observational study. J Antimicrob Chemother 2025:dkaf136. [PMID: 40366637 DOI: 10.1093/jac/dkaf136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 04/22/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Understanding the effects of changes brought by the COVID-19 pandemic on antimicrobial resistance in P. aeruginosa (PA) is essential to inform clinical management. METHODS This single-centre retrospective cohort study included adult inpatients with PA bacteraemia at the University Hospital Zurich between January 2014 and December 2023. The primary outcome was the association between the start of the COVID-19 pandemic and PA with multidrug resistance (MDR), defined as resistance to ≥3 of 5 antibiotic classes. We used logistic regression to adjust for age, sex and ICU treatment. Secondary outcomes included changes in resistance patterns, patient demographics and antimicrobial consumption. RESULTS A total of 493 instances of PA bacteraemia in 333 patients were observed during the study period. The proportion of MDRPA declined from 21% (62/291) pre-pandemic to 9% (19/202) post-pandemic (adjusted OR 0.38, 95% CI 0.18-0.79, p = 0.01). The occurrence of MDRPA during hospitalization following an initial instance of non-MDRPA bacteraemia was rare and unlikely to happen earlier than after 2 weeks. After the start of the pandemic, we observed no MDRPA cases involving cardiovascular or pulmonary diseases and marked reductions in patients with burn injuries or organ transplants. Furthermore, ciprofloxacin and tobramycin use significantly decreased after the start of the pandemic. Overall in-hospital mortality among patients with MDRPA bacteraemia remained high (28%), with no substantial differences between time periods. CONCLUSION We observed a decline in MDRPA occurrence after the start of the COVID-19 pandemic, possibly driven by intensified infection control measures, shifts in antimicrobial use and changes in patient populations.
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Affiliation(s)
- Yulia Butscheid
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pascal M Frey
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Marc Pfister
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lisa Pagani
- Institute of Integrative Biology, ETH Zurich, Zurich, Switzerland
| | - Roger D Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas C Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Willy I Staiger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefano Mancini
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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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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Dabaja-Younis H, Silman Z, Tarabeia J, Hussein K. The impact of the COVID-19 pandemic on hospital-acquired infections and multi-drug resistant organisms, in comparison to seasonal influenza. BMC Infect Dis 2024; 24:1364. [PMID: 39609675 PMCID: PMC11605931 DOI: 10.1186/s12879-024-09240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 03/21/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND While effective preventive measures reduce hospital-acquired infections (HAIs) and the spread of multi-drug resistant organisms (MDROs), studies on the impact of the COVID-19 pandemic and its associated preventive measures remain inconclusive. OBJECTIVE To assess the impact of COVID-19 on HAIs and MDROs and to compare it with the effect of seasonal influenza. METHODS A retrospective cohort study analyzed prospectively collected data from a tertiary hospital in Haifa, northern Israel, from 2016 to 2021. It compared pre/during COVID-19 and influenza (Dec-Feb)/non-influenza (Mar-Nov) seasons. Studied parameters: hospital-acquired bloodstream infections (HA-BSI), MDROs, nosocomial Clostridioides difficile infections (CDI) per 10,000 hospital days (HD), central line-associated BSI (CLABSI) per 1000 catheter days (CD) and hand hygiene compliance (HHC). RESULTS During the COVID-19 period, rates of HAIs and MDROs decreased compared to the pre-COVID era for methicillin-resistant Staphylococcus aureus (MRSA) (4.2 vs. 6.9/10,000 HD; p < 0.001), carbapenem-resistant Acinetobacter baumani (CRAB) (2.2 vs. 3.1/10,000 HD; p = 0.02), and nosocomial CDI (3 vs. 4.6/10,000 HD; p < 0.001). However, there was a higher rate of carbapenem-resistant Enterobacteriaceae (CRE) (4.6 vs. 2.7/10,000 HD; p < 0.001) and HA-BSI (29.7 vs. 27.3/10,000 HD; p = 0.006) during the COVID-19 era. CLABSI rates showed no significant difference (2.3 vs. 2.7/1000 CD; p = 0.910). HHC rate remained at 70% in both eras (p = 0.151). No significant differences were observed in MDROs, CDI, HA-BSI, or CLABSI rates (p = 0.233, 0.675, 0.267, and 0.563, respectively) between influenza and non-influenza seasons. CONCLUSIONS In the COVID-19 era, HAIs and MDROs rates significantly declined, while CRE rates increased, possibly due to a national trend in Israel since 2016. Steady HHC rates suggest additional factors like enhanced environmental cleaning, personal protective equipment usage, and increased infection prevention awareness contributed to this decline. Influenza had no noticeable impact, likely due to healthcare workers' varying perceptions and the brevity of the influenza season, making it challenging to assess impact.
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Affiliation(s)
- Halima Dabaja-Younis
- Paediatric Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel.
- Infection Prevention and Control Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel.
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Zmira Silman
- Independent statistics consultant, Netanya, Israel
| | - Jalal Tarabeia
- Infection Prevention and Control Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel
- The Max Stern Yezreel Valley College, Affola, Israel
| | - Khetam Hussein
- Infection Prevention and Control Unit, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Reffat N, Schwei RJ, Griffin M, Pop-Vicas A, Schulz LT, Pulia MS. A scoping review of bacterial resistance among inpatients amidst the COVID-19 pandemic. J Glob Antimicrob Resist 2024; 38:49-65. [PMID: 38789083 PMCID: PMC11392638 DOI: 10.1016/j.jgar.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic disrupted antimicrobial stewardship and infection prevention operations worldwide, raising concerns for an acceleration of antimicrobial resistance (AMR). Therefore, we aimed to define the scope of peer reviewed research comparing AMR in inpatient bacterial clinical cultures before and after the start of the COVID-19 pandemic. METHODS We conducted a scoping review and searched PubMed, Scopus, and Web of Science through 15 June 2023. Our inclusion criteria were: (1) English language, (2) primary evidence, (3) peer-reviewed, (4) clinical culture data from humans, (5) AMR data for at least one bacterial order/species, (6) inpatient setting, (7) use of statistical testing to evaluate AMR data before and during the COVID-19 pandemic. Reviewers extracted country, study design, type of analysis, study period, setting and population, number of positive cultures or isolates, culture type(s), method of AMR analysis, organisms, and AMR results. Study results were organised by organism and antibiotic class or resistance mechanism. AMR results are also summarised by individual study and across all studies. RESULTS In total, 4805 articles were identified with 55 papers meeting inclusion criteria. Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus were the most commonly studied organisms. There were 464 bacterial AMR results across all studies with 82 (18%) increase, 71 (15%) decrease, and 311 (67%) no change results. CONCLUSIONS The literature examining the impact of COVID-19 on AMR among inpatients is diverse with most results reflecting no change pre/post pandemic. Ongoing inquiry is needed into evolving patterns in AMR post COVID-19.
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Affiliation(s)
- Noora Reffat
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca J Schwei
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Meggie Griffin
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Aurora Pop-Vicas
- Department of Medicine-Division of Infectious Disease, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Lucas T Schulz
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael S Pulia
- BerbeeWalsh Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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de Souza PA, dos Santos MCS, de Miranda RVDSL, da Costa LV, da Silva RPP, de Miranda CAC, da Silva APR, Forsythe SJ, Bôas MHSV, Brandão MLL. Evaluation of Antimicrobial Resistance Patterns of Pseudomonas aeruginosa Strains Isolated among COVID-19 Patients in Brazil Typed by Fourier-Transform Infrared Spectroscopy. Life (Basel) 2024; 14:1079. [PMID: 39337864 PMCID: PMC11433527 DOI: 10.3390/life14091079] [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: 07/23/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/30/2024] Open
Abstract
This study aimed to characterize Pseudomonas aeruginosa strains isolated from hospitalized patients during the COVID-19 pandemic. This was achieved using phenotypic and molecular techniques, including their antimicrobial resistance profile and biofilm formation. Eighteen strains were isolated from a hospital in Rio de Janeiro, Brazil, and identified by VITEK®2, MALDI-TOF/MS (VITEK MS® and MALDI Biotyper®), and 16S rRNA sequencing. Fourier-transform infrared (FTIR) spectroscopy, antimicrobial susceptibility testing, and biofilm formation and disinfectant tolerance tests were applied to evaluate the virulence characteristics of the strains. VITEK®2 (≥99%), VITEK MS® (≥82.7%), and MALDI Biotyper® (score ≥ 2.01) accurately identified the P. aeruginosa strains, but 16S rRNA sequencing did not differentiate the species P. aeruginosa from P. paraeruginosa. FTIR typing identified three different clusters, but no correlation between the phenotypical or antimicrobial susceptibility testing patterns was found. Most strains exhibited resistance to various antimicrobials. The exceptions were sensitivity to amikacin and norfloxacin, and consequently, these could be considered potential treatment options. Most strains (n = 15, 83.3%) produced biofilms on polystyrene. Sodium hypochlorite treatment (0.5%/15 min) was shown to be the most effective disinfectant for biofilm elimination. P. aeruginosa biofilm formation and tolerance to disinfectants demonstrate the need for effective cleaning protocols to eliminate contamination by this organism in the hospital environment and medical equipment.
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Affiliation(s)
- Paula Araujo de Souza
- Laboratory of Microbiology of Food and Sanitizes, INCQS/Fiocruz, Rio de Janeiro 21040-900, Brazil;
- Laboratory of Microbiological Control, Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.C.S.d.S.); (R.V.d.S.L.d.M.); (L.V.d.C.); (M.L.L.B.)
| | - Milena Cristina Silva dos Santos
- Laboratory of Microbiological Control, Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.C.S.d.S.); (R.V.d.S.L.d.M.); (L.V.d.C.); (M.L.L.B.)
| | | | - Luciana Veloso da Costa
- Laboratory of Microbiological Control, Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.C.S.d.S.); (R.V.d.S.L.d.M.); (L.V.d.C.); (M.L.L.B.)
| | | | | | - Ana Paula Roque da Silva
- Analytical Indicators and Data Systems Section, Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil;
| | | | | | - Marcelo Luiz Lima Brandão
- Laboratory of Microbiological Control, Bio-Manguinhos/Fiocruz, Rio de Janeiro 21040-900, Brazil; (M.C.S.d.S.); (R.V.d.S.L.d.M.); (L.V.d.C.); (M.L.L.B.)
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Al Oweidat K, Toubasi AA, Khraisat FA, Aldahabi MN, Alghrabli A, Khater Y, Saleh N, Al-Sayegh TN, Albtoosh AS. The impact of COVID-19 on antibiotic resistance and clinical outcomes among critically ill patients. Am J Infect Control 2024; 52:546-551. [PMID: 38142778 DOI: 10.1016/j.ajic.2023.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the impact of the Coronavirus 2019 (COVID-19) pandemic on antimicrobial resistance, with few studies conducted in low- and middle-income countries. We investigated the impact of the COVID-19 pandemic on multidrug resistant organisms (MDROs) among critically ill patients and their clinical outcomes. METHODS This was a retrospective observational study of patients admitted to the medical Intensive Care Unit at Jordan University Hospital and had blood, urine, or bronchoalveolar bacterial cultures taken during 2 time periods: prepandemic (ie, 1/2016 to 1/2019) and pandemic (ie, 1/2020 to 1/2023). We compared the clinical outcomes (ie, in-hospital deaths, the need for O2 devices, intubation, the length of hospital stay, and the occurrence of complications) and prevalence of MDROs between the 2 periods and conducted multivariate analyses. RESULTS There were 1,254 patients (479 prepandemic and 775 postpandemic. The percentage of patients who had MDROs was significantly higher among patients with a culture taken during the pandemic (82.4%) compared to before it (17.6%) (P-value=.000). Multivariate analysis demonstrated that patients cultured during the pandemic were more than 3 times as likely to have an MDRO (odds ratio = 3.210; 95% confidence interval: 2.236-4.609). CONCLUSIONS The increase in MDROs during the COVID-19 pandemic is an alarming threat to public health; thus, investigating the antibiotic resistance situation as the pandemic subsides is crucial.
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Affiliation(s)
- Khaled Al Oweidat
- Associate Professor at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | | | | | - Ahmad Alghrabli
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yasmeen Khater
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Saleh
- Critical Care Fellow at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Asma S Albtoosh
- Associate Professor at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Teus JK, Mithen L, Green H, Hutton A, Fernandez R. Impact of infection prevention and control practices, including personal protective equipment, on the prevalence of hospital-acquired infections in acute care hospitals during COVID-19: a systematic review and meta-analysis. J Hosp Infect 2024; 147:32-39. [PMID: 38423134 DOI: 10.1016/j.jhin.2024.02.010] [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: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate. AIM To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach. METHODS A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews. FINDINGS Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence. CONCLUSION The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs.
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Affiliation(s)
- J K Teus
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia; School of Nursing, University of Wollongong, NSW, Australia.
| | - L Mithen
- School of Nursing and Midwifery, University of Newcastle, NSW, Australia
| | - H Green
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, NSW, Australia; Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Centre, NSW, Australia
| | - A Hutton
- School of Nursing and Midwifery, University of Newcastle, NSW, Australia; Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Centre, NSW, Australia; School of Nursing, Johns Hopkins University, MD, USA
| | - R Fernandez
- School of Nursing and Midwifery, University of Newcastle, NSW, Australia; Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Centre, NSW, Australia
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Luna-Pineda VM, Rodríguez-Martínez G, Salazar-García M, Romo-Castillo M. Plant-Origin Components: New Players to Combat Antibiotic Resistance in Klebsiella pneumoniae. Int J Mol Sci 2024; 25:2134. [PMID: 38396811 PMCID: PMC10888558 DOI: 10.3390/ijms25042134] [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: 12/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 02/25/2024] Open
Abstract
Klebsiella pneumoniae (Kpn) is an opportunistic pathogen that causes intrahospital complications such as pneumonia, liver abscesses, soft tissue infections, urinary infections, bacteraemia, and, in some cases, death. Since this bacterium has a higher frequency than other Gram-negative pathogens, it has become an important pathogen to the health sector. The adaptative genome of Kpn likely facilitates increased survival of the pathogen in diverse situations. Therefore, several studies have been focused on developing new molecules, synergistic formulations, and biomaterials that make it possible to combat and control infections with and dispersion of this pathogen. Note that the uncontrolled antibiotic administration that occurred during the pandemic led to the emergence of new multidrug-resistant strains, and scientists were challenged to overcome them. This review aims to compile the latest information on Kpn that generates intrahospital infections, specifically their pathogenicity-associated factors. Furthermore, it explains the natural-product-based treatments (extracts and essential oils) developed for Kpn infection and dispersion control.
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Affiliation(s)
- Victor M. Luna-Pineda
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (V.M.L.-P.); (G.R.-M.)
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Griselda Rodríguez-Martínez
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico; (V.M.L.-P.); (G.R.-M.)
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Marcela Salazar-García
- Departamento de Investigación Biomédica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico;
| | - Mariana Romo-Castillo
- IxM/CONAHCYT-HIMFG, Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
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Altorf-van der Kuil W, Wielders CC, Zwittink RD, de Greeff SC, Dongelmans DA, Kuijper EJ, Notermans DW, Schoffelen AF. Impact of the COVID-19 pandemic on prevalence of highly resistant microorganisms in hospitalised patients in the Netherlands, March 2020 to August 2022. Euro Surveill 2023; 28:2300152. [PMID: 38099348 PMCID: PMC10831414 DOI: 10.2807/1560-7917.es.2023.28.50.2300152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/28/2023] [Indexed: 12/17/2023] Open
Abstract
BackgroundThe COVID-19 pandemic resulted in adaptation in infection control measures, increased patient transfer, high occupancy of intensive cares, downscaling of non-urgent medical procedures and decreased travelling.AimTo gain insight in the influence of these changes on antimicrobial resistance (AMR) prevalence in the Netherlands, a country with a low AMR prevalence, we estimated changes in demographics and prevalence of six highly resistant microorganisms (HRMO) in hospitalised patients in the Netherlands during COVID-19 waves (March-June 2020, October 2020-June 2021, October 2021-May 2022 and June-August 2022) and interwaves (July-September 2020 and July-September 2021) compared with pre-COVID-19 (March 2019-February 2020).MethodsWe investigated data on routine bacteriology cultures of hospitalised patients, obtained from 37 clinical microbiological laboratories participating in the national AMR surveillance. Demographic characteristics and HRMO prevalence were calculated as proportions and rates per 10,000 hospital admissions.ResultsAlthough no significant persistent changes in HRMO prevalence were detected, some relevant non-significant patterns were recognised in intensive care units. Compared with pre-COVID-19 we found a tendency towards higher prevalence of meticillin-resistant Staphylococcus aureus during waves and lower prevalence of multidrug-resistant Pseudomonas aeruginosa during interwaves. Additionally, during the first three waves, we observed significantly higher proportions and rates of cultures with Enterococcus faecium (pooled 10% vs 6% and 240 vs 120 per 10,000 admissions) and coagulase-negative Staphylococci (pooled 21% vs 14% and 500 vs 252 per 10,000 admissions) compared with pre-COVID-19.ConclusionWe observed no substantial changes in HRMO prevalence in hospitalised patients during the COVID-19 pandemic.
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Affiliation(s)
- Wieke Altorf-van der Kuil
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Cornelia Ch Wielders
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Romy D Zwittink
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
- Amsterdam University Medical Centers location University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, the Netherlands
| | - Ed J Kuijper
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Daan W Notermans
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Amsterdam University Medical Centers, Department of Medical Microbiology and Infection Prevention, Amsterdam, the Netherlands
| | - Annelot F Schoffelen
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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10
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Quiroga-Vargas E, Loyola-Cruz MÁ, Rojas-Bernabé A, Moreno-Eutimio MA, Pastelin-Palacios R, Cruz-Cruz C, Durán-Manuel EM, Calzada-Mendoza C, Castro-Escarpulli G, Hernández-Hernández G, Cureño-Díaz MA, Fernández-Sánchez V, Bello-López JM. Typing of Candida spp. from Colonized COVID-19 Patients Reveal Virulent Genetic Backgrounds and Clonal Dispersion. Pathogens 2023; 12:1206. [PMID: 37887722 PMCID: PMC10610241 DOI: 10.3390/pathogens12101206] [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: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Advances in the knowledge of the pathogenesis of SARS-CoV-2 allowed the survival of COVID-19 patients in intensive care units. However, due to the clinical characteristics of severe patients, they resulted in the appearance of colonization events. Therefore, we speculate that strains of Candida spp. isolated from COVID-19 patients have virulent genetic and phenotypic backgrounds involved in clinical worsening of patients. The aim of this work was to virutype Candida spp. strains isolated from colonized COVID-19 patients, analyze their genomic diversity, and establish clonal dispersion in care areas. The virulent potential of Candida spp. strains isolated from colonized COVID-19 patients was determined through adhesion tests and the search for genes involved with adherence and invasion. Clonal association was done by analysis of intergenic spacer regions. Six species of Candida were involved as colonizing pathogens in COVID-19 patients. The genotype analysis revealed the presence of adherent and invasive backgrounds. The distribution of clones was identified in the COVID-19 care areas, where C. albicans was the predominant species. Evidence shows that Candida spp. have the necessary genetic tools to be able colonize the lungs, and could be a possible causal agent of coinfections in COVID-19 patients. The detection of dispersion of opportunistic pathogens can be unnoticed by classical epidemiology. Epidemiological surveillance against opportunistic fungal pathogens in COVID-19 patients is an immediate need, since the findings presented demonstrate the potential virulence of Candida spp.
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Affiliation(s)
- Edith Quiroga-Vargas
- Hospital Juárez de México, Mexico City 07760, Mexico (M.Á.L.-C.); (E.M.D.-M.); (M.A.C.-D.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (C.C.-M.)
| | - Miguel Ángel Loyola-Cruz
- Hospital Juárez de México, Mexico City 07760, Mexico (M.Á.L.-C.); (E.M.D.-M.); (M.A.C.-D.)
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Araceli Rojas-Bernabé
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (C.C.-M.)
| | - Mario Adán Moreno-Eutimio
- Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City 04510, Mexico; (M.A.M.-E.); (R.P.-P.)
| | - Rodolfo Pastelin-Palacios
- Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City 04510, Mexico; (M.A.M.-E.); (R.P.-P.)
| | - Clemente Cruz-Cruz
- Hospital Juárez de México, Mexico City 07760, Mexico (M.Á.L.-C.); (E.M.D.-M.); (M.A.C.-D.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (C.C.-M.)
| | - Emilio Mariano Durán-Manuel
- Hospital Juárez de México, Mexico City 07760, Mexico (M.Á.L.-C.); (E.M.D.-M.); (M.A.C.-D.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (C.C.-M.)
| | - Claudia Calzada-Mendoza
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City 11340, Mexico (C.C.-M.)
| | - Graciela Castro-Escarpulli
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | - Geovanni Hernández-Hernández
- Hospital Juárez de México, Mexico City 07760, Mexico (M.Á.L.-C.); (E.M.D.-M.); (M.A.C.-D.)
- Laboratorio de Investigación Clínica y Ambiental, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City 11340, Mexico
| | | | - Verónica Fernández-Sánchez
- Hospital Juárez de México, Mexico City 07760, Mexico (M.Á.L.-C.); (E.M.D.-M.); (M.A.C.-D.)
- Facultad de Estudios Superiores Iztacala, UNAM, Tlalnepantla de Baz 54090, Mexico
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11
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Bolikas E, Astrinaki E, Panagiotaki E, Vitsaxaki E, Saplamidou S, Drositis I, Stafylaki D, Chamilos G, Gikas A, Kofteridis DP, Kritsotakis EI. Impact of SARS-CoV-2 Preventive Measures against Healthcare-Associated Infections from Antibiotic-Resistant ESKAPEE Pathogens: A Two-Center, Natural Quasi-Experimental Study in Greece. Antibiotics (Basel) 2023; 12:1088. [PMID: 37508184 PMCID: PMC10376605 DOI: 10.3390/antibiotics12071088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic led to unprecedented stress on healthcare systems worldwide, forming settings of concern for increasing antimicrobial resistance. We investigated the impact of SARS-CoV-2 preventive measures against healthcare-associated infections (HAIs) from antibiotic-resistant bacteria in two tertiary-care hospitals. We compared infection rates between March 2019 and February 2020 (pre-intervention period) and March 2020 and February 2021 (COVID-19 intervention period) from drug-resistant ESKAPEE bacteria (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci; carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli). Over 24 months, 586 drug-resistant ESKAPEE HAIs occurred in 439 patients (0.3% of 179,629 inpatients) with a mean age of 63 years, with 43% being treated in intensive care units (ICUs), and having a 45% inpatient mortality rate. Interrupted time series analysis revealed increasing infection rates before the intervention that were sharply interrupted by abrupt drops for most pathogens and henceforth remained stable in the ICUs but progressively increased in ordinary wards. In the ICUs, the pooled infection rate was 44% lower over the intervention period compared to the pre-intervention period (incidence rate ratio (IRR) 0.56, 95%CI 0.41-0.75, p < 0.001). Pooled infection rates in the wards were slightly higher over the COVID-19 period (IRR 1.12, 95%CI 0.87-1.45, p = 0.368). The findings confirmed the ancillary beneficial impact of the enhanced bundle of transmission-based precautions adopted against SARS-CoV-2 in rapidly constraining antimicrobial-resistant HAIs in two Greek hospitals.
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Affiliation(s)
- Emmanouil Bolikas
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Eirini Astrinaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Evangelia Panagiotaki
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Clinical Microbiology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Efsevia Vitsaxaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Stamatina Saplamidou
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Ioannis Drositis
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Medical Oncology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios Chamilos
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Achilleas Gikas
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P Kofteridis
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
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12
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Radu VD, Costache RC, Onofrei P, Miftode E, Linga I, Ouatu RM, Boiculese L, Bobeica RL, Tanasa Vasilache I, Mititiuc IL. Multidrug-Resistant (MDR) Urinary Tract Infections Associated with Gut Microbiota in CoV and Non-CoV Patients in a Urological Clinic during the Pandemic: A Single Center Experience. Antibiotics (Basel) 2023; 12:973. [PMID: 37370292 DOI: 10.3390/antibiotics12060973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of the study was to compare the profile of COVID-19 (CoV)-infected patients with non-COVID-19 (non-CoV) patients who presented with a multidrug-resistant urinary tract infection (MDR UTI) associated with gut microbiota, as well as analyze the risk factors for their occurrence, the types of bacteria involved, and their spectrum of sensitivity. METHODS We conducted a case-control study on patients admitted to the urology clinic of the "Parhon" Teaching Hospital in Iasi, Romania, between March 2020 and August 2022. The study group consisted of 22 CoV patients with MDR urinary infections associated with gut microbiota. For the control group, 66 non-CoV patients who developed MDR urinary infections associated with gut microbiota were selected. Electronic medical records were analyzed to determine demographics, characteristics, and risk factors. The types of urinary tract bacteria involved in the occurrence of MDR urinary infections and their sensitivity spectrum were also analyzed. RESULTS Patients in both groups studied were over 60 years of age, with no differences in gender, environment of origin, and rate of comorbidities. Patients in the CoV group had a higher percentage of urosepsis (54.5% versus 21.2%, p < 0.05) and more hospitalization days (9.27 versus 6.09, p < 0.05). Regarding risk factors, the two groups had similar percentages of previous urologic interventions (95.45% versus 96.97%, p > 0.05), antibiotic therapy (77.3% versus 87.9%, p > 0.05), and the presence of permanent urinary catheters (77.27% versus 84.85%, p > 0.05). Escherichia coli (31.8% versus 42.4%, p > 0.05), Klebsiella spp. (22.7% versus 34.8%, p > 0.05), and Pseudomonas aeruginosa (27.3% versus 9.1%, p > 0.05) were the most common urinary tract bacteria found in the etiology of MDR urinary infections in CoV and non-CoV patients. A high percentage of the involved MDR urinary tract bacteria were resistant to quinolones (71.4-76.2% versus 80.3-82%, p > 0.05) and cephalosporins (61.9-81% versus 63.9-83.6%, p > 0.05), both in CoV and non-CoV patients. CONCLUSIONS Patients with urological interventions who remain on indwelling urinary catheters are at an increased risk of developing MDR urinary infections associated with gut microbiota resistant to quinolones and cephalosporins. Patients with MDR UTIs who have CoV-associated symptoms seem to have a higher rate of urosepsis and a longer hospitalization length.
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Affiliation(s)
- Viorel Dragos Radu
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Radu Cristian Costache
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Pavel Onofrei
- Department of Morpho-Functional Sciences II, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Egidia Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Iacov Linga
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Radu Mihaita Ouatu
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Lucian Boiculese
- Department of Preventive and Interdisciplinarity, Medical Informatics and Biostatistics, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Razvan Lucian Bobeica
- Department of Urology and Renal Transplantation, "C.I. Parhon" University Hospital, 700115 Iasi, Romania
| | - Ingrid Tanasa Vasilache
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
| | - Irina Luanda Mititiuc
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania
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13
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Bongiovanni M, Barda B. Pseudomonas aeruginosa Bloodstream Infections in SARS-CoV-2 Infected Patients: A Systematic Review. J Clin Med 2023; 12:jcm12062252. [PMID: 36983256 PMCID: PMC10056033 DOI: 10.3390/jcm12062252] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Bacterial co-infections increase the severity of respiratory viral infections and are frequent causes of mortality in COVID-19 infected subjects. During the COVID-19 period, especially at the beginning of the pandemic, an inappropriate use of broad-spectrum antibiotic treatments has been frequently described, mainly due to prolonged hospitalization, especially in intensive care unit departments, and the use of immune-suppressive treatments as steroids. This misuse has finally led to the occurrence of infections by multi-drug resistant (MDR) bacteria in hospitalized COVID-19 patients. Although different reports assessed the prevalence of Gram-negative infections in COVID-19 infected patients, scarce data are currently available on bloodstream infections caused by Pseudomonas aeruginosa in hospitalized COVID-19 patients. The aim of our systematic review is to describe data on this specific population and to discuss the possible implications that these co-infections could have in the management of COVID-19 pandemics in the future. We systematically analysed the current literature to find all the relevant articles that describe the occurrence of P. aeruginosa bloodstream infections in COVID-19 patients. We found 40 papers that described in detail P. aeruginosa HAIs-BSI in COVID-19 patients, including 756,067 patients overall. The occurrence of severe infections due to MDR bacteria had a significant impact in the management of hospitalized patients with COVID-19 infections, leading to a prolonged time of hospitalization and to a consequent increase in mortality. In the near future, the increased burden of MDR bacteria due to the COVID-19 pandemic might partially be reduced by maintaining the preventive measures of infection control implemented during the acute phase of the COVID-19 pandemic. Finally, we discuss how the COVID-19 pandemic changed the role of antimicrobial stewardship in healthcare settings, according to the isolation of MDR bacteria and how to restore on a large scale the optimization of antibiotic strategies in COVID-19 patients.
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14
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Pinheiro FR, Rozza-de-Menezes RE, Blum MC, Pereira RFA, Rocha JA, Guedes Pinto MCF, Penna BA, Riley LW, Aguiar-Alves F. Evaluation of changes in antimicrobial susceptibility in bacteria infecting children and their mothers in pediatric, neonatal-intensive care unit, and gynecology/obstetrics wards of a quaternary referral hospital during the COVID-19 pandemic. Front Microbiol 2023; 14:1096223. [PMID: 36891399 PMCID: PMC9986255 DOI: 10.3389/fmicb.2023.1096223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023] Open
Abstract
The World Health Organization released a statement warning of increased risk for the incidence of multidrug resistant microorganisms and the absence of new drugs to control such infections soon. Since the beginning of the COVID-19 pandemic, the prescription of antimicrobial agents has increased and may have accelerated the emergence of multidrug resistant (MDR) bacteria. This study aimed to evaluate maternal and pediatric infections within a hospital from January 2019 to December 2021. An observational retrospective cohort study was performed at a quaternary referral hospital in a metropolitan area of Niteroi city, Rio de Janeiro state, Brazil. A total of 196 patients' medical records were analyzed. The data from 90 (45.9%) patients were collected before the SARS-CoV-2 pandemic, 29 (14.8%) from the 2020 pandemic period, and 77 (39.3%) from the 2021 pandemic period. A total of 256 microorganisms were identified during this period. Out of those, 101 (39.5%) were isolated in 2019, 51 (19.9%) in 2020, and 104 (40.6%) in 2021. Antimicrobial susceptibility tests were performed on 196 (76.6%) clinical isolates. The exact binomial test showed that the distribution of Gram-negative bacteria was predominant. The most common microorganism was Escherichia coli (23%; n = 45), followed by Staphylococcus aureus (17.9%, n = 35), Klebsiella pneumoniae (12.8%, n = 25), Enterococcus faecalis (7.7%, n = 15), Staphylococcus epidermidis (6.6%, n = 13) and Pseudomonas aeruginosa (5.6%, n = 11). Staphylococcus aureus was the predominant species among resistant bacteria. Among the antimicrobial agents tested, the following were resistant, presented on a descending scale: penicillin (72.7%, p = 0.001, Binomial test), oxacillin (68.3%, p = 0.006, Binomial test), ampicillin (64.3%, p = 0.003, Binomial test), and ampicillin/sulbactam (54.9%, p = 0.57, Binomial test). Infections with S. aureus were 3.1 times greater in pediatrics and maternal units than in other hospital wards. Despite the global reduction in the incidence of MRSA, we observed an increase in MDR S. aureus in this study. No changes were observed in the frequency of resistance profiles of the clinical isolates after the establishment of the global SARS-CoV-2 pandemic. More comprehensive studies are needed to understand the impact of the global SARS-CoV-2 pandemic on the resistance levels of bacteria associated with neonate and pediatric patients.
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Affiliation(s)
- Felipe Ramos Pinheiro
- Molecular Epidemiology and Biotechnology Laboratory, School of Pharmacy, Fluminense Federal University, Niteroi, Brazil.,Pathology Post Graduate Program, School of Medicine, Fluminense Federal University, Niteroi, Brazil
| | | | - Marina Camille Blum
- Division of Health and Social Behavior, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Renata Freire Alves Pereira
- Molecular Epidemiology and Biotechnology Laboratory, School of Pharmacy, Fluminense Federal University, Niteroi, Brazil.,Applied Microbiology and Parasitology Post Graduate Programs, Fluminense Federal University, Niteroi, Brazil
| | - Jaqueline Abel Rocha
- Epidemiological Surveillance Unit, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Maria Cristina F Guedes Pinto
- Epidemiological Surveillance Unit, Antonio Pedro University Hospital, Fluminense Federal University, Niteroi, Brazil
| | - Bruno A Penna
- Gram-Positive Cocci Laboratory, Biomedical Institute Fluminense Federal University, Niteroi, Brazil
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Fabio Aguiar-Alves
- Pathology Post Graduate Program, School of Medicine, Fluminense Federal University, Niteroi, Brazil.,Applied Microbiology and Parasitology Post Graduate Programs, Fluminense Federal University, Niteroi, Brazil.,Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, United States
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15
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Witt LS, Howard-Anderson JR, Jacob JT, Gottlieb LB. The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review. JAC Antimicrob Resist 2022; 5:dlac130. [PMID: 36601548 PMCID: PMC9798082 DOI: 10.1093/jacamr/dlac130] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) changed healthcare across the world. With this change came an increase in healthcare-associated infections (HAIs) and a concerning concurrent proliferation of MDR organisms (MDROs). In this narrative review, we describe the impact of COVID-19 on HAIs and MDROs, describe potential causes of these changes, and discuss future directions to combat the observed rise in rates of HAIs and MDRO infections.
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Affiliation(s)
- Lucy S Witt
- Corresponding author. E-mail: ; @drwittID, @JessH_A, @jestjac
| | - Jessica R Howard-Anderson
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
| | - Jesse T Jacob
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
| | - Lindsey B Gottlieb
- Division of Infection Diseases, Emory University School of Medicine, Atlanta, GA, USA,Emory Antibiotic Resistance Group, Emory University, Atlanta, GA, USA
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16
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Brink AJ, Richards G, Tootla H, Prentice E. Epidemiology of Gram-negative bacteria during coronavirus disease 2019. What is the real pandemic? Curr Opin Infect Dis 2022; 35:595-604. [PMID: 36345854 DOI: 10.1097/qco.0000000000000864] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Bacterial infections play a key role in hospital outcomes during the coronavirus disease 2019 (COVID-19) pandemic. Nonetheless, the global impact on the epidemiology of Gram-negative bacteria (GNB) and antibiotic resistance has not been clearly established. RECENT FINDINGS Multiple limitations exist in the current literature, in that substantial variability was observed with regard to methodology. Notwithstanding the heterogeneity, the evidence suggests that the COVID-19 pandemic had a substantial negative impact on global epidemiology with an increase in hospital-onset infections, associated with GNB. Similarly, an alarming increase in resistant GNB compared to prepandemic rates, was apparent. This was most evident for carbapenemase-producing Klebsiella pneumoniae (bloodstream infections), carbapenem-resistant Pseudomonas aeruginosa (ventilator-associated pneumonia), and carbapenem-resistant Acinetobacter baumannii (all infections). Significant variations were most apparent in the large, system-wide regional or national comparative assessments, vs. single-centre studies. Categorizing concurrent bacteria as co- or secondary-infections may be paramount to optimize standard of care. SUMMARY The data from most studies signal the probability that COVID-19 accelerated resistance. However, multiple limitations intrinsic to interpretation of current COVID-19 data, prevents accurately quantifying collateral damage on the global epidemiology and antibiotic resistance amongst GNB. It is likely to be substantial and renewed efforts to limit further increases is warranted.
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Affiliation(s)
- Adrian J Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town
| | - Guy Richards
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Hafsah Tootla
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town.,National Health Laboratory Service, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Elizabeth Prentice
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town.,National Health Laboratory Service, Groote Schuur Hospital, Cape Town
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17
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Reduced Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) colonization in a hematological-emergency setting during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2022; 43:1963-1965. [PMID: 35400354 PMCID: PMC9043629 DOI: 10.1017/ice.2022.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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18
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Pérez Jorge G, Rodrigues dos Santos Goes IC, Gontijo MTP. Les misérables: a Parallel Between Antimicrobial Resistance and COVID-19 in Underdeveloped and Developing Countries. Curr Infect Dis Rep 2022; 24:175-186. [PMID: 36211535 PMCID: PMC9531231 DOI: 10.1007/s11908-022-00788-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 12/02/2022]
Abstract
Purpose of Review The COVID-19 pandemic has been responsible for more than 6.3 million deaths worldwide. During the pandemic, the indiscriminate use of antibiotics has increased, contributing to the spread of multidrug-resistant bacteria. In this review, we aim to determine the spread and impact of antibiotic treatments in patients with COVID-19, focusing on underdeveloped and developing countries. Recent Findings Meta-analysis revealed that bacterial co-infections and secondary infections are relatively rare in COVID-19 patients, corresponding to less than 20% of hospitalized patients. Even so, most of these patients have received antibiotic treatments. Summary This review discusses how the COVID-19 pandemic could increase the emergence of multidrug-resistant strains to currently available antibiotics. Initially, we discussed the spread and impact of multidrug resistance of ESKAPE pathogens associated with nosocomial infections and analyzed their risk of secondary infections in patients with COVID-19. Then we highlight three factors related to the spread of resistant bacteria during the current pandemic: overprescription of antibiotics followed by self-medication. Finally, we discussed the lack of availability of diagnostic tests to discriminate the etiologic agent of a disease. All these factors lead to inappropriate use of antibiotics and, therefore, to an increase in the prevalence of resistance, which can have devastating consequences shortly. The data compiled in this study underscore the importance of epidemiological surveillance of hospital isolates to provide new strategies for preventing and controlling infections caused by multidrug-resistant bacteria. In addition, the bibliographic research also highlights the need for an improvement in antibiotic prescribing in the health system.
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Affiliation(s)
- Genesy Pérez Jorge
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas, Rua Monteiro Lobato 255, Campinas, SP 13083-862 Brazil
- Laboratorio de Investigaciones Biomédicas, Universidad de Sucre, Cra. 28 #5-267, Sincelejo, Sucre, Colômbia
| | - Isabella Carolina Rodrigues dos Santos Goes
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas, Rua Monteiro Lobato 255, Campinas, SP 13083-862 Brazil
| | - Marco Tulio Pardini Gontijo
- Departamento de Genética, Evolução, Microbiologia e Imunologia, Instituto de Biologia, Universidade Estadual de Campinas, Rua Monteiro Lobato 255, Campinas, SP 13083-862 Brazil
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, 10 Duke Medicine Cir, Durham, NC 27710 USA
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19
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Prevalence and Antimicrobial Resistance of Bloodstream Infections Caused by ESKAPEEc Pathogens: A Five-year Analysis. Jundishapur J Microbiol 2022. [DOI: 10.5812/jjm-122990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Antimicrobial resistance in ESKAPEEc (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli) pathogens causing bloodstream infections (BSIs) is a growing threat to clinicians and public health. Objectives: Our purpose was to determine the prevalence and susceptibility of ESKAPEEcs causing BSI over five years (2016 to 2020) at a large tertiary hospital in Istanbul, Turkey. Methods: Of 2591 unique isolates obtained from blood culture specimens, 1.281 (49.4%) were positive for ESKAPEEc pathogens. The ESKAPEEc rates increased from 2016 to 2019 and decreased during the COVID-19 pandemic. Results: The most common pathogen was K. pneumoniae (34.3%). Carbapenem resistant (CR) K. pneumoniae was 61.8% and A. baumannii was 90.4%. The percentages of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant E. faecium (VRE) were 38.6% and 29.4%, respectively. Conclusions: Our findings showed a high incidence of ESKAPEEc and AMR in BSIs. Antibiotic policies and restrictions in health care settings and the community will play an essential role in the solution in the future.
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Zhang C, Yang M. Antimicrobial Peptides: From Design to Clinical Application. Antibiotics (Basel) 2022; 11:349. [PMID: 35326812 PMCID: PMC8944448 DOI: 10.3390/antibiotics11030349] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Infection of multidrug-resistant (MDR) bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, brings public health issues and causes economic burden. Pathogenic bacteria develop several methods to resist antibiotic killing or inhibition, such as mutation of antibiotic function sites, activation of drug efflux pumps, and enzyme-mediated drug degradation. Antibiotic resistance components can be transferred between bacteria by mobile genetic elements including plasmids, transposons, and integrons, as well as bacteriophages. The development of antibiotic resistance limits the treatment options for bacterial infection, especially for MDR bacteria. Therefore, novel or alternative antibacterial agents are urgently needed. Antimicrobial peptides (AMPs) display multiple killing mechanisms against bacterial infections, including directly bactericidal activity and immunomodulatory function, as potential alternatives to antibiotics. In this review, the development of antibiotic resistance, the killing mechanisms of AMPs, and especially, the design, optimization, and delivery of AMPs are reviewed. Strategies such as structural change, amino acid substitution, conjugation with cell-penetration peptide, terminal acetylation and amidation, and encapsulation with nanoparticles will improve the antimicrobial efficacy, reduce toxicity, and accomplish local delivery of AMPs. In addition, clinical trials in AMP studies or applications of AMPs within the last five years were summarized. Overall, AMPs display diverse mechanisms of action against infection of pathogenic bacteria, and future research studies and clinical investigations will accelerate AMP application.
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Affiliation(s)
- Chunye Zhang
- Department of Veterinary Pathobiology, University of Missouri, Columbia, MO 65212, USA;
| | - Ming Yang
- Department of Surgery, University of Missouri, Columbia, MO 65211, USA
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Stojowska-Swędrzyńska K, Łupkowska A, Kuczyńska-Wiśnik D, Laskowska E. Antibiotic Heteroresistance in Klebsiella pneumoniae. Int J Mol Sci 2021; 23:449. [PMID: 35008891 PMCID: PMC8745652 DOI: 10.3390/ijms23010449] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Klebsiella pneumoniae is one of the most common pathogens responsible for infections, including pneumonia, urinary tract infections, and bacteremias. The increasing prevalence of multidrug-resistant K. pneumoniae was recognized in 2017 by the World Health Organization as a critical public health threat. Heteroresistance, defined as the presence of a subpopulation of cells with a higher MIC than the dominant population, is a frequent phenotype in many pathogens. Numerous reports on heteroresistant K. pneumoniae isolates have been published in the last few years. Heteroresistance is difficult to detect and study due to its phenotypic and genetic instability. Recent findings provide strong evidence that heteroresistance may be associated with an increased risk of recurrent infections and antibiotic treatment failure. This review focuses on antibiotic heteroresistance mechanisms in K. pneumoniae and potential therapeutic strategies against antibiotic heteroresistant isolates.
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Affiliation(s)
| | | | | | - Ewa Laskowska
- Department of General and Medical Biochemistry, Faculty of Biology, University of Gdansk, Wita Stwosza 59, 80-308 Gdansk, Poland; (K.S.-S.); (A.Ł.); (D.K.-W.)
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