Analysis of the Trends of Methicillin-Resistant Staphylococcus aureus in Gauteng Public Hospitals from 2009 to 2018

ESKAPE pathogen incidence and antibiotic resistance in patients with bloodstream infections at a referral hospital in Limpopo, South Africa, 2014-2019: A cross-sectional study

Background

There is a paucity of research on the incidence and antimicrobial resistance (AMR) of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE) pathogens in Africa because of the inadequate establishment of AMR surveillance systems.

Objective

This study reports on the incidence and AMR of bloodstream ESKAPE pathogens at a referral hospital in northern South Africa.

Methods

This retrospective descriptive study used routinely collected bloodstream isolates (pathogen identification and antimicrobial susceptibility testing performed using automated systems) from the South African National Health Laboratory Service, from January 2014 to December 2019. Resistant phenotypes analysed included methicillin-resistant S. aureus and carbapenem-resistant A. baumannii.

Results

The ESKAPE pathogen incidence rate was stable from 2014 to 2019 (p = 0.133). The most isolated pathogens were S. aureus (268/746; 35.9%) and A. baumannii (200/746; 26.8%). Staphylococcus aureus increased from 39 isolates in 2014 to 75 in 2019 (p = 0.132). The incidence rate of A. baumannii increased from 11.9% (16/134) in 2015 to 37.8% (68/180) in 2019 (p = 0.009). Most isolates (417/746; 55.9%) were from the neonatal ward. Carbapenem-resistant A. baumannii increased from 68.8% (11/16) in 2014 to 75.0% (51/68) in 2019 (p = 0.009). Methicillin-resistant S. aureus decreased from 56.0% (14/25) in 2016 to 17.3% (13/75) in 2019 (p = 0.260).

Conclusion

Routine data provide essential information on the incidence of ESKAPE pathogens and AMR phenotypes, serving as a basis for an antibiogram, a surveillance tool in antibiotic stewardship programmes.

What this study adds

The study provided local information on the incidence and AMR pattern of ESKAPE pathogens, which is essential when developing empiric treatment protocols for appropriate antibiotic prescribing and infection prevention and control practices.

The Prevalence of Alert Pathogens and Microbial Resistance Mechanisms: A Three-Year Retrospective Study in a General Hospital in Poland

The development of antibiotic resistance mechanisms hinders the treatment process. So far, there is limited data on the problem of bacterial resistance in hospitals in Central and Eastern Europe. Therefore, this study aimed to assess the prevalence of resistance mechanisms and alert pathogens based on reports regarding cultures of samples collected from general hospital patients in Poland in the period 2019-2021. This study examined the prevalence of resistance mechanisms and alert pathogens and the structure of microorganisms, including the type of diagnostic material in the hospital department. The frequency of occurrence and the trends were analysed based on Cochran's Q-test, relative change and the average annual rate of change (AARC). Of all 14,471 cultures, 3875 were positive for bacteria, and 737 were characterised by resistance mechanisms (19.0%). Alert pathogens were identified in 983 cases (24.6%), including pathogens isolated from blood samples. The most commonlyisolated bacteria were Escherichia coli (>20% of positive cultures), Enterococcus faecalis (7%), and Klebsiella pneumoniae (6%) increasing over time; Staphylococcus aureus (13%) was also found, but its proportion was decreasing over time. Extended-spectrum β-lactamase (ESBL) was the most frequent resistance mechanism in Internal Medicine (IM) (p < 0.001) and the Intensive Care Unit (ICU) (p < 0.01), as well as in ICU-COVID; this increased over the study period (AARC ↑34.9%). Methicillin-resistant Staphylococcus aureus (MRSA) (AARC ↓50.82%) and AmpC beta-lactamase (AARC ↓24.77%) prevalence fell over time. Also, the number of alert pathogens was dominant in the IM (p < 0.01) and ICU (p < 0.001). The most common alert pathogen was ESBL-positive E. coli. Gram-negative rods constitute a significant epidemiological problem in hospitals, especially the growing trend of ESBL in IM and ICU, which calls for increased control of sanitary procedures.