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Khoshbakht R, Kabiri M, Neshani A, Khaksari MN, Sadrzadeh SM, Mousavi SM, Ghazvini K, Ghavidel M. Assessment of antibiotic resistance changes during the Covid-19 pandemic in northeast of Iran during 2020-2022: an epidemiological study. Antimicrob Resist Infect Control 2022; 11:121. [PMID: 36182905 PMCID: PMC9526201 DOI: 10.1186/s13756-022-01159-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background The coronavirus disease 2019 seems to change antibiotic resistance pattern. Certain conditions in the Covid-19 era may be contributing to the rise of antimicrobial resistance (AMR). Due to the limited information on the impact of Covid-19 on antimicrobial resistance (AMR), the purpose of this research was to investigate the trend in antimicrobial resistance changes of E. coli, P. aeruginosa, K. pneumoniae, and A. baumannii in Hasheminezhad hospital. This hospital was a Corona center in Mashhad at the onset of this epidemic. Methods 1672 clinical samples were collected between January 21, 2020 and January 30, 2022from patients hospitalized at Hasheminezhad Hospital in Mashhad, Conventional microbiological procedures for identifying gram-negative bacteria and antibiotic susceptibility testing were used, according to the clinical and laboratory standards institute (CLSI) 2021. The two years of the pandemic, from the initial stage of the outbreak until the 6th peak, (January 2020 to and January 2022) were divided into 9 periods according to the seasons. Results Highest resistance rates were seen in E. coli (615 samples), K. pneumoniae (351 samples), P. aeruginosa (362 samples) and A. baumannii (344 samples) to Ampicillin (89.6%), Ampicillin (98%), Imipenem (91.8%), and Ceftazidime (94.6%), respectively. The largest change in antibiotic resistance was seen between Summer 2020 and Summer 2021 for K. pneumoniae with about a 30% rise in antibiotic resistance to Ceftriaxone. Conclusions All 4 species evaluated in this study, have shown rising AMR rates during the first year of the pandemic in the northeast of Iran. This study revealed that E. coli, P. aeruginosa, K. pneumoniae, and A. baumannii strains in Northern Iran have a higher level of antibiotic resistance than what was measured in similar studies conducted before the pandemic. This will further restrict treatment choices and jeopardize global public health.
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Affiliation(s)
- Reza Khoshbakht
- grid.411583.a0000 0001 2198 6209Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mona Kabiri
- grid.411583.a0000 0001 2198 6209Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Neshani
- grid.411583.a0000 0001 2198 6209Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Navid Khaksari
- grid.411583.a0000 0001 2198 6209Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Majid Sadrzadeh
- grid.411583.a0000 0001 2198 6209Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mohammad Mousavi
- grid.411583.a0000 0001 2198 6209Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- grid.411583.a0000 0001 2198 6209Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdis Ghavidel
- grid.411583.a0000 0001 2198 6209Shahid Hasheminejad Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Suda T, Hanawa T, Tanaka M, Tanji Y, Miyanaga K, Hasegawa-Ishii S, Shirato K, Kizaki T, Matsuda T. Modification of the immune response by bacteriophages alters methicillin-resistant Staphylococcus aureus infection. Sci Rep 2022; 12:15656. [PMID: 36123529 PMCID: PMC9483902 DOI: 10.1038/s41598-022-19922-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
There is an urgent need to develop phage therapies for multidrug-resistant bacterial infections. However, although bacteria have been shown to be susceptible to phage therapy, phage therapy is not sufficient in some cases. PhiMR003 is a methicillin-resistant Staphylococcus aureus phage previously isolated from sewage influent, and it has demonstrated high lytic activity and a broad host range to MRSA clinical isolates in vitro. To investigate the potential of phiMR003 for the treatment of MRSA infection, the effects of phiMR003 on immune responses in vivo were analysed using phiMR003-susceptible MRSA strains in a mouse wound infection model. Additionally, we assessed whether phiMR003 could affect the immune response to infection with a nonsusceptible MRSA strain. Interestingly, wounds infected with both susceptible and nonsusceptible MRSA strains treated with phiMR003 demonstrated decreased bacterial load, reduced inflammation and accelerated wound closure. Moreover, the infiltration of inflammatory cells in infected tissue was altered by phiMR003. While the effects of phiMR003 on inflammation and bacterial load disappeared with heat inactivation of phiMR003. Transcripts of proinflammatory cytokines induced by lipopolysaccharide were reduced in mouse peritoneal macrophages. These results show that the immune modulation occurring as a response to the phage itself improves the clinical outcomes of phage therapy.
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Affiliation(s)
- Tomoya Suda
- Department of General Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Tomoko Hanawa
- Department of Infectious Diseases, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Mayuko Tanaka
- Department of Infectious Diseases, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yasunori Tanji
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 J3-8 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, 226-8501, Japan
| | - Kazuhiko Miyanaga
- School of Life Science and Technology, Tokyo Institute of Technology, 4259 J3-8 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, 226-8501, Japan.,Division of Bacteriology, Department of Infection and Immunity, School of Medicine, Jichi Medical University, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Sanae Hasegawa-Ishii
- Pathology Research Team, Faculty of Health Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka, Tokyo, 181-8612, Japan
| | - Ken Shirato
- Department of Molecular Predictive Medicine and Sport Science, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takako Kizaki
- Department of Molecular Predictive Medicine and Sport Science, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takeaki Matsuda
- Department of General Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan. .,Department of Traumatology and Critical Care Medicine, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
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Ioannou P, Astrinaki E, Vitsaxaki E, Bolikas E, Christofaki D, Salvaraki A, Lagoudaki E, Ioannidou E, Karakonstantis S, Saplamidou S, Cleovoulou C, Stamataki E, Ilia S, Messaritaki A, Avdi M, Chalkiadaki A, Papathanasaki S, Markopoulou C, Magouli E, Moustaki M, Kataxaki VA, Skevakis P, Spernovasilis N, Chamilos G, Kofteridis DP. A Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Public Acute Care Hospitals in Crete, Greece. Antibiotics (Basel) 2022; 11:antibiotics11091258. [PMID: 36140037 PMCID: PMC9495163 DOI: 10.3390/antibiotics11091258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Both healthcare-associated infections (HAIs) and antimicrobial resistance are associated with an increased length of stay and hospital costs, while they have also been linked to high morbidity and mortality rates. In 2016 and 2017, the latest point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals highlighted an HAI prevalence of 6.5%, while Greece had a higher HAI prevalence of 10%. The aim of this PPS was to record the prevalence of HAIs and antimicrobial use in all eight public acute care hospitals in Crete, Greece during the COVID-19 pandemic in order to highlight the types of infections and antimicrobial practices that need to be prioritized for infection control initiatives. Methods: The PPS was conducted between 30 March and 15 April 2022, according to the ECDC standardized relevant protocol (version 5.3). Statistics were extracted using the ECDC Helics.Win.Net application (software version 4.1.0). Results: A total of 1188 patients were included. The overall point prevalence of patients with at least one HAI was 10.6%. The most frequent types of infections were pneumonia (34.3%), bloodstream infections (10.5%), systemic infections and urinary tract infections (10.5% and 9.1%, respectively). In 14 (12.4%) cases, the pathogen responsible for HAI was SARS-CoV-2 following onsite spread, accounting for almost 10% of all HAIs. Microorganisms were identified in 60.1% of HAIs. Antimicrobials were administered in 711 (59.8%) patients, with 1.59 antimicrobials used per patient. Conclusion: The prevalence of HAI and antimicrobial use among hospitalized patients in Crete, Greece was similar to the national HAI prevalence in 2016 despite the enormous pressure on public hospitals due to the COVID-19 pandemic. Nevertheless, both HAI prevalence and antimicrobial use remain high, underlining the need to implement adequate infection control and antimicrobial stewardship interventions.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
- Correspondence: (P.I.); (D.P.K.)
| | - Eirini Astrinaki
- Infection Control Committee, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Efsevia Vitsaxaki
- Infection Control Committee, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Emmanouil Bolikas
- Infection Control Committee, “Venizeleio-Pananeio” General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Despoina Christofaki
- Infection Control Committee, Organic Unit of Agios Nikolaos, General Hospital of Lasithi/General Hospital-Health Center of Neapoli “Dialinakio”, 72100 Agios Nikolaos, Greece
| | - Apostolia Salvaraki
- Infection Control Committee, General Hospital of Rethymno, 74132 Rethymno, Greece
| | - Eirini Lagoudaki
- Infection Control Committee, General Hospital of Chania “St. George”, 73300 Chania, Greece
| | - Eleni Ioannidou
- Infection Control Committee, General Hospital of Rethymno, 74132 Rethymno, Greece
| | | | - Stamatina Saplamidou
- Infection Control Committee, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Christos Cleovoulou
- Infection Control Committee, General Hospital of Chania “St. George”, 73300 Chania, Greece
| | - Eleni Stamataki
- Infection Control Committee, General Hospital of Chania “St. George”, 73300 Chania, Greece
| | - Stavroula Ilia
- Pediatric Intensive Care Unit, University Hospital of Heraklion, 71500 Heraklion, Greece
- School of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Argyri Messaritaki
- Office of Nursing Services, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Michaela Avdi
- Internal Medicine, General Hospital of Rethymno, 74132 Rethymno, Greece
| | - Anthoula Chalkiadaki
- Infection Control Committee, Organic Unit of Agios Nikolaos, General Hospital of Lasithi/General Hospital-Health Center of Neapoli “Dialinakio”, 72100 Agios Nikolaos, Greece
| | - Styliani Papathanasaki
- Infection Control Committee, Decentralized Organic Unit of Sitia, General Hospital of Lasithi/General Hospital-Health Center of Neapoli “Dialinakio”, 72300 Sitia, Greece
| | - Chrisanthi Markopoulou
- Infection Control Committee, Decentralized Organic Unit of Ierapetra, General Hospital of Lasithi/General Hospital-Health Center of Neapoli “Dialinakio”, 72200 Ierapetra, Greece
| | - Evagelia Magouli
- Infection Control Committee, General Hospital-Health Care Center of Neapoli “Dialinakeio”, 72400 Neapoli, Greece
| | - Maria Moustaki
- Infection Control Committee, Decentralized Organic Unit of Sitia, General Hospital of Lasithi/General Hospital-Health Center of Neapoli “Dialinakio”, 72300 Sitia, Greece
| | - Vasileia-Athina Kataxaki
- Infection Control Committee, Decentralized Organic Unit of Sitia, General Hospital of Lasithi/General Hospital-Health Center of Neapoli “Dialinakio”, 72300 Sitia, Greece
| | - Panagiotis Skevakis
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), 15451 Athens, Greece
| | - Nikolaos Spernovasilis
- School of Medicine, University of Crete, 71500 Heraklion, Greece
- German Oncology Center, 4108 Limassol, Cyprus
| | - Georgios Chamilos
- Department of Clinical Microbiology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
- Correspondence: (P.I.); (D.P.K.)
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Cogliati Dezza F, Arcari G, Alessi F, Valeri S, Curtolo A, Sacco F, Ceccarelli G, Raponi G, Alessandri F, Mastroianni CM, Venditti M, Oliva A. Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared. Antibiotics (Basel) 2022; 11:926. [PMID: 35884179 PMCID: PMC9312122 DOI: 10.3390/antibiotics11070926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Two mutually related pandemics are ongoing worldwide: the COVID-19 and antimicrobial resistance pandemics. This study aims to evaluate the impact of COVID-19 on multi-drug-resistant Gram-negative bacteria (MDR-GN) bloodstream infections (BSIs) in a single intensive care unit (ICU). We conducted a retrospective study including patients admitted to the ICU, reorganized for COVID-19 patients' healthcare, with at least one confirmed MDR-GN BSI during 2019-2020. We compared clinical and microbiological features, incidence density, antibiotic therapy and mortality rate in pre- and during-COVID-19 pandemic periods. We estimated the impact of COVID-19 on mortality by means of univariate Cox regression analyses. A total of 46 patients were included in the study (28 non-COVID-19/18 COVID-19). Overall, 63 BSI episodes occurred (44/19), and non-COVID-19 patients had a higher incidence of MDR-GN BSIs and were more likely to present K. pneumoniae BSIs, while the COVID-19 group showed more A. baumannii BSIs with higher per pathogen incidence. COVID-19 patients presented more critical conditions at the BSI onset, a shorter hospitalization time from BSI to death and higher 30-day mortality rate from BSI onset. COVID-19 and septic shock were associated with 30-day mortality from MDR-GN BSIs, while early active therapy was a protective factor. In conclusion, COVID-19 showed a negative impact on patients with MDR-GN BSIs admitted to the ICU.
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Affiliation(s)
- Francesco Cogliati Dezza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Gabriele Arcari
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.A.); (F.S.); (G.R.)
| | - Federica Alessi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Serena Valeri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Ambrogio Curtolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Federica Sacco
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.A.); (F.S.); (G.R.)
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Giammarco Raponi
- Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy; (G.A.); (F.S.); (G.R.)
| | - Francesco Alessandri
- Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy;
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.A.); (S.V.); (A.C.); (G.C.); (C.M.M.); (M.V.)
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Tavares G, Alves P, Simões P. Recent Advances in Hydrogel-Mediated Nitric Oxide Delivery Systems Targeted for Wound Healing Applications. Pharmaceutics 2022; 14:pharmaceutics14071377. [PMID: 35890273 PMCID: PMC9315818 DOI: 10.3390/pharmaceutics14071377] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the noticeable evolution in wound treatment over the centuries, a functional material that promotes correct and swift wound healing is important, considering the relative weight of chronic wounds in healthcare. Difficult to heal in a fashionable time, chronic wounds are more prone to infections and complications thereof. Nitric oxide (NO) has been explored for wound healing applications due to its appealing properties, which in the wound healing context include vasodilation, angiogenesis promotion, cell proliferation, and antimicrobial activity. NO delivery is facilitated by molecules that release NO when prompted, whose stability is ensured using carriers. Hydrogels, popular materials for wound dressings, have been studied as scaffolds for NO storage and delivery, showing promising results such as enhanced wound healing, controlled and sustained NO release, and bactericidal properties. Systems reported so far regarding NO delivery by hydrogels are reviewed.
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Wang Y, Zhao X, Li Y, Wang N, Jiang F, Lambert H, Yan F, Fu C, Jiang Q. Patterns and Determinants of Antibiotic Use Behaviors among Rural Community Residents in Eastern China. Antibiotics (Basel) 2022; 11:823. [PMID: 35740229 PMCID: PMC9220009 DOI: 10.3390/antibiotics11060823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 01/01/2023] Open
Abstract
Inappropriate antibiotic use may lead to antibiotic resistance, which has become a serious global crisis. Addressing suboptimal antibiotic use in the general population can play a significant role in the fight against antimicrobial resistance. This study aims to describe antibiotic use and sources of acquisition, and to identify factors influencing antibiotic access among rural community residents in Eastern China. A cross-sectional survey was conducted from July to August 2020, and 1494 participants from two villages in Eastern China were enrolled. Information was obtained using face-to-face interviews with a structured electronic questionnaire. Chi-squared and multinominal logistic regression analysis were used to explore possible determinants. In total, 1379 participants were eligible for the analysis. In the past 12 months, nearly half the respondents had taken any antibiotic (48.4%), and this proportion varied across marital status and age group. Two thirds of them (59.9%) obtained antibiotics from medical facilities with a prescription when they last took antibiotics, while 17.7% and 22.4% chose retail pharmacies and other sources, respectively. Multinominal analysis found that a higher proportion obtained antibiotics outside medical facilities among those aged 15 to 44 years, unmarried, non-white collar workers, with more years of education, lower annual household income per capita and lower levels of antibiotic knowledge. The antibiotic use behavior of rural community residents in Eastern China remains suboptimal. Antibiotic use and access behaviors need to be further addressed. Effective antibiotic stewardship in non-medical facility sources and training programs targeted for rural Chinese is warranted in future.
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Affiliation(s)
- Yanhuan Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Xinping Zhao
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Yurong Li
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Na Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Feng Jiang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Fei Yan
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Chaowei Fu
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai 200032, China; (Y.W.); (X.Z.); (Y.L.); (N.W.); (F.J.); (F.Y.); (Q.J.)
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Pérez de la Lastra JM, Anand U, González-Acosta S, López MR, Dey A, Bontempi E, Morales delaNuez A. Antimicrobial Resistance in the COVID-19 Landscape: Is There an Opportunity for Anti-Infective Antibodies and Antimicrobial Peptides? Front Immunol 2022; 13:921483. [PMID: 35720330 PMCID: PMC9205220 DOI: 10.3389/fimmu.2022.921483] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
Although COVID-19 has captured most of the public health attention, antimicrobial resistance (AMR) has not disappeared. To prevent the escape of resistant microorganisms in animals or environmental reservoirs a "one health approach" is desirable. In this context of COVID-19, AMR has probably been affected by the inappropriate or over-use of antibiotics. The increased use of antimicrobials and biocides for disinfection may have enhanced the prevalence of AMR. Antibiotics have been used empirically in patients with COVID-19 to avoid or prevent bacterial coinfection or superinfections. On the other hand, the measures to prevent the transmission of COVID-19 could have reduced the risk of the emergence of multidrug-resistant microorganisms. Since we do not currently have a sterilizing vaccine against SARS-CoV-2, the virus may still multiply in the organism and new mutations may occur. As a consequence, there is a risk of the appearance of new variants. Nature-derived anti-infective agents, such as antibodies and antimicrobial peptides (AMPs), are very promising in the fight against infectious diseases, because they are less likely to develop resistance, even though further investigation is still required.
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Affiliation(s)
- José M. Pérez de la Lastra
- Biotechnology of Macromolecules, Instituto de Productos Naturales y Agrobiología, IPNA (CSIC), San Cristóbal de la Laguna, Spain
| | - Uttpal Anand
- Department of Life Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sergio González-Acosta
- Biotechnology of Macromolecules, Instituto de Productos Naturales y Agrobiología, IPNA (CSIC), San Cristóbal de la Laguna, Spain
| | - Manuel R. López
- Biotechnology of Macromolecules, Instituto de Productos Naturales y Agrobiología, IPNA (CSIC), San Cristóbal de la Laguna, Spain
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, India
| | - Elza Bontempi
- National Interuniversity Consortium of Materials Science and Technology (INSTM) and Chemistry for Technologies Laboratory, Department of Mechanical and Industrial Engineering, University of Brescia, Brescia, Italy
| | - Antonio Morales delaNuez
- Biotechnology of Macromolecules, Instituto de Productos Naturales y Agrobiología, IPNA (CSIC), San Cristóbal de la Laguna, Spain
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Chiș AA, Rus LL, Morgovan C, Arseniu AM, Frum A, Vonica-Țincu AL, Gligor FG, Mureșan ML, Dobrea CM. Microbial Resistance to Antibiotics and Effective Antibiotherapy. Biomedicines 2022; 10:biomedicines10051121. [PMID: 35625857 PMCID: PMC9138529 DOI: 10.3390/biomedicines10051121] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 12/24/2022] Open
Abstract
Currently, the efficacy of antibiotics is severely affected by the emergence of the antimicrobial resistance phenomenon, leading to increased morbidity and mortality worldwide. Multidrug-resistant pathogens are found not only in hospital settings, but also in the community, and are considered one of the biggest public health concerns. The main mechanisms by which bacteria develop resistance to antibiotics include changes in the drug target, prevention of entering the cell, elimination through efflux pumps or inactivation of drugs. A better understanding and prediction of resistance patterns of a pathogen will lead to a better selection of active antibiotics for the treatment of multidrug-resistant infections.
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Falcone M, Suardi LR, Tiseo G, Galfo V, Occhineri S, Verdenelli S, Ceccarelli G, Poli M, Merli M, Bavaro D, Carretta A, Nunnari G, Venanzi Rullo E, Trecarichi EM, Papalini C, Franco A, Del Vecchio RF, Bianco V, Punzi R, Francisci D, Rubino R, Torti C, Puoti M, Carbonara S, Cascio A, Saracino A, Santantonio T, Venditti M, Menichetti F. Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study). JAC Antimicrob Resist 2022; 4:dlac064. [PMID: 35719203 PMCID: PMC9201238 DOI: 10.1093/jacamr/dlac064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE).
Methods
Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-β-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality.
Results
Overall, 123 patients (median age 66 years, IQR 59–75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) (n = 64, 52%), followed by urinary-tract infections (UTI) (n = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (n = 28, 22.8%), intra-abdominal infections (n = 2, 1.6%) and skin infections (n = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09–24.97, P = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33–11.77, P = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44–6.26, P = 0.003) and age (HR 1.05, 95% CI 1.02–1.08, P = 0.002) were predictors of 30 day mortality.
Conclusions
Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients.
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Affiliation(s)
- Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Valentina Galfo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Stefano Verdenelli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome , Italy
| | - Melita Poli
- Vittorio Emanuele II Hospital , Bisceglie , Italy
| | - Marco Merli
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Davide Bavaro
- University of Bari, Clinic of Infectious Diseases , Bari , Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital ‘Ospedali Riuniti’ of Foggia , Foggia , Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina , Messina , Italy
| | - Enrico Maria Trecarichi
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro-‘Mater Domini’ Teaching Hospital , Catanzaro , Italy
| | - Chiara Papalini
- Department of Medicine and Surgery, Clinic of Infectious Diseases, ‘Santa Maria della Misericordia’ Hospital, University of Perugia , Perugia , Italy
| | | | | | - Vincenzo Bianco
- Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital , Naples , Italy
| | - Rodolfo Punzi
- Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital , Naples , Italy
| | - Daniela Francisci
- Department of Medicine and Surgery, Clinic of Infectious Diseases, ‘Santa Maria della Misericordia’ Hospital, University of Perugia , Perugia , Italy
| | - Raffaella Rubino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo , Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro-‘Mater Domini’ Teaching Hospital , Catanzaro , Italy
| | - Massimo Puoti
- Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | | | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo , Palermo , Italy
| | | | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital ‘Ospedali Riuniti’ of Foggia , Foggia , Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome , Rome , Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa , Pisa , Italy
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60
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So M, Walti L. Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients. Curr Infect Dis Rep 2022; 24:63-75. [PMID: 35535263 PMCID: PMC9055217 DOI: 10.1007/s11908-022-00778-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae, are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.
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Affiliation(s)
- Miranda So
- Toronto General Hospital, University Health Network, 9th Floor Munk Building, Room 800, 585 University Avenue, Toronto, ON M5G 2N2 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Canada
| | - Laura Walti
- Toronto General Hospital, University Health Network, 9th Floor Munk Building, Room 800, 585 University Avenue, Toronto, ON M5G 2N2 Canada
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61
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Ergen P, Koçoğlu ME, Nural M, Kuşkucu MA, Aydin Ö, İnal FY, Öztürk H, Üçişik AC, Çaşkurlu H, Güneysu B, Yildirim B, Midilli K, Çağ Y, Arslan F, Vahaboglu H. Carbapenem-resistant Klebsiella pneumoniae outbreak in a COVID-19 intensive care unit; a case-control study. J Chemother 2022; 34:517-523. [PMID: 35470780 DOI: 10.1080/1120009x.2022.2064698] [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: 10/18/2022]
Abstract
We analysed a carbapenem-resistant Klebsiella pneumoniae (CRKP) outbreak in the coronavirus disease (COVID) ICU. We retrospectively collected data from ICU records. We identified 25 cases between 12 November 2020 and 19 December 2020, and compared them to 42 controls present in the ICU during the same period. The presence of a femoral haemodialysis catheter was strongly associated with invasive CRKP infections (cases, 9 [36%]; controls, 0 [0%]; odds ratio [OR] 95% confidence intervals [CIs], 21 (5; 89)). We found a significant association between old age and CRKP infection with adverse outcomes. Sequence analysis revealed three distinct carbapenemase genes: blaNDM-1, blaOXA-48 and blaKPC-2. We launched rectal swab sampling upon admission to the ICU, cohorted colonized patients and cases and conducted an intensive training programme for newly employed staff. This study revealed that the emergence and dissemination of CRKP in COVID ICUs were associated with increased adverse outcomes. The presence of a femoral haemodialysis catheter was a significant risk factor for CRKP infections.
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Affiliation(s)
- Pınar Ergen
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - M Esra Koçoğlu
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Müge Nural
- Anestesi ve Rehabilitasyon Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Mert Ahmet Kuşkucu
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Cerrahpaşa Tıp Fakültes, İstanbul Üniversitesi, İstanbul, Turkiye
| | - Özlem Aydin
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Ferda Y İnal
- Anestesi ve Rehabilitasyon Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Hande Öztürk
- Anestesi ve Rehabilitasyon Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Ayşe C Üçişik
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Hülya Çaşkurlu
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Büşra Güneysu
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Büşra Yildirim
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Kenan Midilli
- Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı, Cerrahpaşa Tıp Fakültes, İstanbul Üniversitesi, İstanbul, Turkiye
| | - Yasemin Çağ
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Ferhat Arslan
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
| | - Haluk Vahaboglu
- Enfeksiyon Hastalıkları Anabilim Dalı, Tıp Fakultesi, İstanbul Medeniyet Üniversitesi, İstanbul, Turkiye
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Schons MJ, Caliebe A, Spinner CD, Classen AY, Pilgram L, Ruethrich MM, Rupp J, Nunes de Miranda SM, Römmele C, Vehreschild J, Jensen BE, Vehreschild M, Degenhardt C, Borgmann S, Hower M, Hanses F, Haselberger M, Friedrichs AK. All-cause mortality and disease progression in SARS-CoV-2-infected patients with or without antibiotic therapy: an analysis of the LEOSS cohort. Infection 2022; 50:423-436. [PMID: 34625912 PMCID: PMC8500268 DOI: 10.1007/s15010-021-01699-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Reported antibiotic use in coronavirus disease 2019 (COVID-19) is far higher than the actual rate of reported bacterial co- and superinfection. A better understanding of antibiotic therapy in COVID-19 is necessary. METHODS 6457 SARS-CoV-2-infected cases, documented from March 18, 2020, until February 16, 2021, in the LEOSS cohort were analyzed. As primary endpoint, the correlation between any antibiotic treatment and all-cause mortality/progression to the next more advanced phase of disease was calculated for adult patients in the complicated phase of disease and procalcitonin (PCT) ≤ 0.5 ng/ml. The analysis took the confounders gender, age, and comorbidities into account. RESULTS Three thousand, six hundred twenty-seven cases matched all inclusion criteria for analyses. For the primary endpoint, antibiotic treatment was not correlated with lower all-cause mortality or progression to the next more advanced (critical) phase (n = 996) (both p > 0.05). For the secondary endpoints, patients in the uncomplicated phase (n = 1195), regardless of PCT level, had no lower all-cause mortality and did not progress less to the next more advanced (complicated) phase when treated with antibiotics (p > 0.05). Patients in the complicated phase with PCT > 0.5 ng/ml and antibiotic treatment (n = 286) had a significantly increased all-cause mortality (p = 0.029) but no significantly different probability of progression to the critical phase (p > 0.05). CONCLUSION In this cohort, antibiotics in SARS-CoV-2-infected patients were not associated with positive effects on all-cause mortality or disease progression. Additional studies are needed. Advice of local antibiotic stewardship- (ABS-) teams and local educational campaigns should be sought to improve rational antibiotic use in COVID-19 patients.
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Affiliation(s)
- Maximilian J. Schons
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Amke Caliebe
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Kiel University, Kiel, Germany
| | - Christoph D. Spinner
- School of Medicine, Department of Internal Medicine II, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Annika Y. Classen
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Lisa Pilgram
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Maria M. Ruethrich
- Institute for Infection Medicine and Hospital Hygiene, University Hospital Jena, Jena, Germany
| | - Jan Rupp
- University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Christoph Römmele
- Internal Medicine III – Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Augsburg, Germany
| | - Janne Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | - Bjoern-Erik Jensen
- Clinic for Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria Vehreschild
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Frankfurt am Main, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Martin Hower
- Department of Pneumology, Infectious Diseases and Intensive Care, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Frank Hanses
- Interdisciplinary Emergency Department, University Hospital Regensburg, Regensburg, Germany
| | | | - Anette K. Friedrichs
- Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Fontana C, Favaro M, Minelli S, Bossa MC, Altieri A, Celeste M, Pennacchiotti C, Sarmati L, Andreoni M, Cucchi C, Magrini A. Antimicrobial resistance in the times of COVID-19 in a roman teaching hospital. ALL LIFE 2022. [DOI: 10.1080/26895293.2022.2058620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Carla Fontana
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Laboratory of Microbiology, University Hospital “Tor Vergata”, Rome, Italy
| | - Marco Favaro
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Silvia Minelli
- Laboratory of Microbiology, University Hospital “Tor Vergata”, Rome, Italy
| | | | - Anna Altieri
- Laboratory of Microbiology, University Hospital “Tor Vergata”, Rome, Italy
| | | | | | - Loredana Sarmati
- Department of System Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Infectious Diseases Clinic, University Hospital “Tor Vergata”, Rome, Italy
| | - Massimo Andreoni
- Department of System Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Infectious Diseases Clinic, University Hospital “Tor Vergata”, Rome, Italy
| | - Carmela Cucchi
- Health Department, University Hospital “Tor Vergata”, Rome, Italy
| | - Andrea Magrini
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
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Ayoub Moubareck C, Hammoudi Halat D. The Collateral Effects of COVID-19 Pandemic on the Status of Carbapenemase-Producing Pathogens. Front Cell Infect Microbiol 2022; 12:823626. [PMID: 35372126 PMCID: PMC8968076 DOI: 10.3389/fcimb.2022.823626] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/27/2022] [Indexed: 12/28/2022] Open
Abstract
The serious challenge of antimicrobial resistance continues to threaten public health and lingers in the era of the coronavirus disease 2019 (COVID-19), declared pandemic by the World Health Organization. While the pandemic has triggered the importance of infection control practices and preventive measures such as physical distancing, hand hygiene, travel reduction and quarantine, the ongoing alarm of antimicrobial resistance seems to accompany the pandemic too. Antimicrobial resistance has been fostered during COVID-19, possibly due to high rate of empirical antibiotic utilization in COVID-19 patients, increased use of biocides, and the disruption of proper healthcare for other conditions. Specifically, carbapenemase-producing Gram-negative bacteria have shown to cause secondary bacterial infections in patients hospitalized for COVID-19. Clinical and microbiological evidence of such infections is accumulating in different parts of the world. With the resilient nature of carbapenemases, their association with mortality, and the limited treatment options available, concerns regarding this group of antibiotic-hydrolyzing enzymes during the pandemic are expected to upsurge. While the additional burden carbapenemases exert on healthcare is worrisome, it remains hidden or abandoned among the various health consequences of the pandemic. The purpose of this minireview is to shed a light on carbapenemase-associated infections during such unprecedented time of COVID-19. A focused insight shall be made into carbapenemases, their implications for COVID-19 patients, and the features and consequences of co-infection, with a review of available evidence from pertinent literature. The importance of increased surveillance for carbapenemase-producers and optimizing their management in relation to the pandemic, shall be addressed as well.
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Affiliation(s)
| | - Dalal Hammoudi Halat
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese International University, Bekaa, Lebanon
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65
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A comparative assessment of action plans on antimicrobial resistance from OECD and G20 countries using natural language processing. Health Policy 2022; 126:522-533. [DOI: 10.1016/j.healthpol.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/18/2022]
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66
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Impact of the COVID-19 pandemic on multidrug-resistant hospital-acquired bacterial infections. J Hosp Infect 2022; 123:191-192. [PMID: 35245646 PMCID: PMC8885440 DOI: 10.1016/j.jhin.2022.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/06/2023]
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Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients. Antibiotics (Basel) 2022; 11:antibiotics11020276. [PMID: 35203877 PMCID: PMC8868529 DOI: 10.3390/antibiotics11020276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022] Open
Abstract
In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p < 0.05) was noted between the hospitalized COVID-19 patients and bacterial co-infections. Staphylococcus aureus (S. aureus) showed high resistance against tetracycline (61.7%), Streptococcus pyogenes against penicillin (100%), E. coli against Amp-clavulanic acid (88.72%), Klebsiella pneumoniae against ampicillin (100%), and Pseudomonas aeruginosa against ciprofloxacin (75.40%). Acinetobacter baumannii was 100% resistant to the majority of tested antibiotics. The prevalence of methicillin-resistant S. aureus (MRSA) was 14.7%. The topmost symptoms of >50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended.
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It is complicated: Potential short- and long-term impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance—An expert review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e27. [PMID: 36310817 PMCID: PMC9614949 DOI: 10.1017/ash.2022.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
As of December 2021, the coronavirus disease 2019 (COVID-19) pandemic has claimed millions of deaths and caused disruptions in health systems around the world. The short- and long-term effects of COVID-19 on antimicrobial resistance (AMR), which was already a global threat before the pandemic, are manifold and complex. In this expert review, we summarize how COVID-19 might be affecting AMR in the short term (by influencing the key determinants antibiotic use, infection control practices and international/local mobility) and which additional factors might play a role in the long term. Whereas reduced outpatient antibiotic use in high-income countries, increased awareness for hand hygiene, and reduced mobility have likely mitigated the emergence and spread of AMR in the short term, factors such as overuse of antibiotics in COVID-19 patients, shortage of personal protective equipment, lack of qualified healthcare staff, and patient overcrowding have presumably facilitated its propagation. Unsurprisingly, international and national AMR surveillance data for 2020 show ambiguous trends. Although disruptions in antibiotic stewardship programs, AMR surveillance and research might promote the spread of AMR, other developments could prove beneficial to the cause in the long term. These factors include the increased public awareness for infectious diseases and infection control issues, the strengthening of the One Health perspective as outlined by the Centers for Disease Control and Prevention, and the unprecedented number of international research collaborations and platforms. These factors could even serve as leverage and provide opportunities to better combat AMR in the future.
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‘Superbugs’: raising public awareness of antimicrobial resistance through a pop-up science shop. RESEARCH FOR ALL 2022. [DOI: 10.14324/rfa.06.1.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
‘Superbugs: A Pop-up Science Shop’ was a public engagement event in the school summer holidays of 2019, organised by members of Cardiff University’s School of Medicine. We transformed an empty retail unit in the centre of Wales’s largest shopping centre into an interactive and immersive microbiology experience. We facilitated two-way dialogue to impart positive impact on the awareness of antibiotic resistance, while concurrently evaluating the efficacy of an engagement strategy focused on the utilisation of public spaces to attract public demographics diverse to those who would normally engage with conventional science, technology, engineering and mathematics (STEM) outreach. Over the course of 14 days, we welcomed 6,566 visitors, with 67 per cent attending as part of the natural footfall of the shopping centre. We created 1,626 young Antibiotic Resistance Champions, located in over two hundred schools, across many of the most deprived areas in Wales. We imparted a positive impact to our stakeholders, with a significant increase in the knowledge and understanding of the subject of antimicrobial resistance (AMR); 91.7 per cent indicated that they had a better understanding after the event. In this article, we discuss the evolution of ‘Superbugs’ from concept, planning and design, to the logistics of delivering an engagement event of this scale. We focus in particular on the learning outcomes of the project, and on how this will shape the future of our ‘Superbugs’ project, and engagement events beyond.
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Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda. Antibiotics (Basel) 2022; 11:antibiotics11020199. [PMID: 35203802 PMCID: PMC8868487 DOI: 10.3390/antibiotics11020199] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations.
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71
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da Costa RL, Lamas CDC, Simvoulidis LFN, Espanha CA, Moreira LPM, Bonancim RAB, Weber JVLA, Ramos MRF, Silva ECDF, de Oliveira LP. Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance. Rev Inst Med Trop Sao Paulo 2022; 64:e6. [PMID: 35137900 PMCID: PMC8815857 DOI: 10.1590/s1678-9946202264006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/15/2021] [Indexed: 12/23/2022] Open
Abstract
Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.
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Affiliation(s)
- Rafael Lessa da Costa
- Hospital Unimed-Rio, Unidade de Terapia Intensiva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristiane da Cruz Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro, Brazil
- Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Unigranrio, Rio de Janeiro, Rio de Janeiro, Brazil
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Papst L, Luzzati R, Carević B, Tascini C, Gorišek Miksić N, Vlahović Palčevski V, Djordjevic ZM, Simonetti O, Sozio E, Lukić M, Stevanović G, Petek D, Beović B. Antimicrobial Use in Hospitalised Patients with COVID-19: An International Multicentre Point-Prevalence Study. Antibiotics (Basel) 2022; 11:antibiotics11020176. [PMID: 35203779 PMCID: PMC8868464 DOI: 10.3390/antibiotics11020176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Studies suggest that the incidence of coinfections in patients with the coronavirus disease 2019 (COVID-19) is low, but a large number of patients receive antimicrobials during hospitalisation. This may fuel a rise in antimicrobial resistance (AMR). We conducted a multicentre point-prevalence survey in seven tertiary university hospitals (in medical wards and intensive care units) in Croatia, Italy, Serbia and Slovenia. Of 988 COVID-19 patients, 521 were receiving antibiotics and/or antifungals (52.7%; range across hospitals: 32.9–85.6%) on the day of the study. Differences between hospitals were statistically significant (χ2 (6, N = 988) = 192.57, p < 0.001). The majority of patients received antibiotics and/or antifungals within 48 h of admission (323/521, 62%; range across hospitals: 17.4–100%), their most common use was empirical (79.4% of prescriptions), and pneumonia was the main indication for starting the treatment (three-quarters of prescriptions). The majority of antibiotics prescribed (69.9%) belonged to the “Watch” group of the World Health Organization AWaRe classification. The pattern of antimicrobial use differed across hospitals. The data show that early empiric use of broad-spectrum antibiotics is common in COVID-19 patients, and that the pattern of antimicrobial use varies across hospitals. Judicious use of antimicrobials is warranted to prevent an increase in AMR.
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Affiliation(s)
- Lea Papst
- Department of Infectious Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; (M.L.); (B.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- Correspondence:
| | - Roberto Luzzati
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini 50, 34148 Trieste, Italy; (R.L.); (O.S.)
| | - Biljana Carević
- Department of Hospital Epidemiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (B.C.); (G.S.)
| | - Carlo Tascini
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Via Pozzuolo 33, 33100 Udine, Italy; (C.T.); (E.S.)
| | - Nina Gorišek Miksić
- Department of Infectious Diseases, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.G.M.); (D.P.)
| | - Vera Vlahović Palčevski
- Unit of Clinical Pharmacology, Clinical Hospital Center Rijeka, Krešimirova ulica 42, 51000 Rijeka, Croatia;
| | - Zorana M. Djordjevic
- Department of Hospital Infections Control, University Clinical Centre Kragujevac, Zmaj Jovina 30, 34000 Kragujevac, Serbia;
| | - Omar Simonetti
- Department of Infectious Diseases, Azienda Sanitaria Universitaria Giuliano Isontina, Via Giacomo Puccini 50, 34148 Trieste, Italy; (R.L.); (O.S.)
| | - Emanuela Sozio
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Via Pozzuolo 33, 33100 Udine, Italy; (C.T.); (E.S.)
| | - Milica Lukić
- Department of Infectious Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; (M.L.); (B.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Goran Stevanović
- Department of Hospital Epidemiology, University Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia; (B.C.); (G.S.)
| | - Davor Petek
- Department of Infectious Diseases, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (N.G.M.); (D.P.)
| | - Bojana Beović
- Department of Infectious Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia; (M.L.); (B.B.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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73
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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] [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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Impact of coronavirus disease 2019 on infectious disease treatment and infection control at a tertiary hospital in Japan. J Infect Chemother 2022; 28:616-622. [PMID: 35115242 PMCID: PMC8789558 DOI: 10.1016/j.jiac.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 11/23/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) has greatly impacted medical care practices. Although the effects on infectious disease treatment and infection control, such as antimicrobial resistance, have been specified, very few reports exist on the specific effects of COVID-19. Methods We investigated the effects of COVID-19 on daily medical practices at a tertiary hospital in Japan by comparing the use of hand sanitizers, the detection of bacteria from blood cultures, and the amount dose of antibacterial drugs used for one year before (April 2019 to March 2020, fiscal year 2019.) and after COVID-19 admissions began (April 2020 to March 2021, fiscal year 2020). Results The use of hand sanitizers increased by 1.4–3 times during the year after COVID-19 admissions began; the incidence of methicillin-susceptible Staphylococcus aureus and all S. aureus detected in blood cultures reduced in all departments. No decrease was observed in the usage of all antibacterial drugs; rather, the usage of all antibacterial drugs tended to increase in all departments. Therefore, no significant change was observed in the detection of drug-resistant bacteria and the trends of antibacterial drug use based on the acceptance of COVID-19 patients. Conclusions The prevalence of drug-resistant bacteria and trends of antibacterial drug use remained unchanged despite the increased use of hand sanitizers due to the admission of patients with COVID-19.
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The Usage of Antibiotics by COVID-19 Patients with Comorbidities: The Risk of Increased Antimicrobial Resistance. Antibiotics (Basel) 2021; 11:antibiotics11010035. [PMID: 35052912 PMCID: PMC8772884 DOI: 10.3390/antibiotics11010035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global health issue that plays a significant role in morbidity and mortality, especially in immunocompromised patients. It also becomes a serious threat to the successful treatment of many bacterial infections. The widespread and irrelevant use of antibiotics in hospitals and local clinics is the leading cause of AMR. Under this scenario, the study was conducted in a tertiary care hospital in Lahore, Pakistan, from 2 August 2021 to 31 October 2021 to discover the prevalence of bacterial infections and AMR rates in COVID-19 patients admitted in surgical intensive care units (SICUs). Clinical samples were collected from the patients and we proceeded to identify bacterial isolates, followed by antibiotic susceptibility testing (AST) using the Kirby Bauer disk diffusion method and minimum inhibitory concentration (MIC). The data of other comorbidities were also collected from the patient’s medical record. The current study showed that the most common pathogens were E. coli (32%) and Klebsiella pneumoniae (17%). Most E. coli were resistant to ciprofloxacin (16.8%) and ampicillin (19.8%). Klebsiella pneumoniae were more resistant to ampicillin (13.3%) and amoxycillin (12.0%). The most common comorbidity was chronic kidney disease (CKD) and urinary tract infections (UTIs). Around 17 different types of antibiotic, the carbapenem, fluoroquinolones, aminoglycoside, and quinolones, were highly prevalent in ICU patients. The current study provides valuable data on the clinical implication of antibiotics consumed by COVID-19 patients in SICUs and the AMR rates, especially with different comorbidities.
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76
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Rajni E, Singh A, Tarai B, Jain K, Shankar R, Pawar K, Mamoria V, Chowdhary A. A High Frequency of Candida auris Blood Stream Infections in Coronavirus Disease 2019 Patients Admitted to Intensive Care Units, Northwestern India: A Case Control Study. Open Forum Infect Dis 2021; 8:ofab452. [PMID: 34904116 PMCID: PMC8522362 DOI: 10.1093/ofid/ofab452] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/06/2021] [Indexed: 12/20/2022] Open
Abstract
Background The ongoing pandemic of coronavirus disease 2019 (COVID-19) has overwhelmed healthcare facilities and raises an important novel concern of nosocomial transmission of Candida species in the intensive care units (ICUs). Methods We evaluated the incidence and risk factors for development of candidemia in 2384 COVID-19 patients admitted during August 2020–January 2021 in ICUs of 2 hospitals (Delhi and Jaipur) in India. A 1:2 case-control matching was used to identify COVID-19 patients who did not develop candidemia as controls. Results A total of 33 patients developed candidemia and accounted for an overall incidence of 1.4% over a median ICU stay of 24 days. A 2-fold increase in the incidence of candidemia in COVID-19 versus non-COVID-19 patients was observed with an incidence rate of 14 and 15/1000 admissions in 2 ICUs. Candida auris was the predominant species (42%) followed by Candida tropicalis. Multivariable regression analysis revealed the use of tocilizumab, duration of ICU stay (24 vs 14 days), and raised ferritin level as an independent predictor for the development of candidemia. Azole resistance was observed in C auris and C tropicalis harboring mutations in the azole target ERG11 gene. Multilocus sequence typing (MLST) identified identical genotypes of C tropicalis in COVID-19 patients, raising concern for nosocomial transmission of resistant strains. Conclusions Secondary bacterial infections have been a concern with the use of tocilizumab. In this cohort of critically ill COVID-19 patients, tocilizumab was associated with the development of candidemia. Surveillance of antifungal resistance is warranted to prevent transmission of multidrug-resistant strains of nosocomial yeasts in COVID-19 hospitalized patients.
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Affiliation(s)
- Ekadashi Rajni
- Department of Microbiology, Mahatma Gandhi University of Medical Science & Technology, Jaipur, Rajasthan, India
| | - Ashutosh Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Kusum Jain
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.,Department of Zoology, Ramjas College, University of Delhi, Delhi, India
| | - Ravi Shankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Kalpana Pawar
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vedprakash Mamoria
- Department of Microbiology, Mahatma Gandhi University of Medical Science & Technology, Jaipur, Rajasthan, India
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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Borek AJ, Maitland K, McLeod M, Campbell A, Hayhoe B, Butler CC, Morrell L, Roope LSJ, Holmes A, Walker AS, Tonkin-Crine S. Impact of the COVID-19 Pandemic on Community Antibiotic Prescribing and Stewardship: A Qualitative Interview Study with General Practitioners in England. Antibiotics (Basel) 2021; 10:antibiotics10121531. [PMID: 34943743 PMCID: PMC8698307 DOI: 10.3390/antibiotics10121531] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 01/21/2023] Open
Abstract
The COVID-19 pandemic has had a profound impact on the delivery of primary care services. We aimed to identify general practitioners’ (GPs’) perceptions and experiences of how the COVID-19 pandemic influenced antibiotic prescribing and antimicrobial stewardship (AMS) in general practice in England. Twenty-four semi-structured interviews were conducted with 18 GPs at two time-points: autumn 2020 (14 interviews) and spring 2021 (10 interviews). Interviews were audio-recorded, transcribed and analysed thematically, taking a longitudinal approach. Participants reported a lower threshold for antibiotic prescribing (and fewer consultations) for respiratory infections and COVID-19 symptoms early in the pandemic, then returning to more usual (pre-pandemic) prescribing. They perceived the pandemic as having had less impact on antibiotic prescribing for urinary and skin infections. Participants perceived the changing ways of working and consulting (e.g., proportions of remote and in-person consultations) in addition to changing patient presentations and GP workloads as influencing the fluctuations in antibiotic prescribing. This was compounded by decreased engagement with, and priority of, AMS due to COVID-19-related urgent priorities. Re-engagement with AMS is needed, e.g., through reviving antibiotic prescribing feedback and targets/incentives. The pandemic disrupted, and required adaptations in, the usual ways of working and AMS. It is now important to identify opportunities, e.g., for re-organising ways of managing infections and AMS in the future.
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Affiliation(s)
- Aleksandra J. Borek
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
- Correspondence:
| | - Katherine Maitland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
| | - Monsey McLeod
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK; (M.M.); (A.C.); (A.H.)
- Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, London W6 8RF, UK
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London W6 8RF, UK
| | - Anne Campbell
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK; (M.M.); (A.C.); (A.H.)
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK;
- NIHR Applied Research Collaboration Northwest London, London W6 8RP, UK
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
| | - Liz Morrell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (L.M.); (L.S.J.R.)
| | - Laurence S. J. Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK; (L.M.); (L.S.J.R.)
- NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK;
| | - Alison Holmes
- National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK; (M.M.); (A.C.); (A.H.)
| | - Ann Sarah Walker
- NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK;
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; (K.M.); (C.C.B.); (S.T.-C.)
- NIHR Oxford Biomedical Research Centre, Oxford OX3 9DU, UK;
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The Impact of the SARS-Cov2 Pandemic on a Persuasive Educational Antimicrobial Stewardship Program in a University Hospital in Southern Italy: A Pre-Post Study. Antibiotics (Basel) 2021; 10:antibiotics10111405. [PMID: 34827343 PMCID: PMC8614883 DOI: 10.3390/antibiotics10111405] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: We evaluated the effect of the pandemic on the disruption of a persuasive educational antimicrobial stewardship program (ASP) conducted in a university hospital in southern Italy. Methods: In March 2020, the ASP, which began in January 2017 and was carried out at different times in 10 wards, was stopped due to the COVID-19 pandemic. We conducted an observational study with interrupted time series analysis to compare the antibiotic consumption and costs, average length of hospital stay and in-hospital mortality between 12 months before and 9 months after the interruption. Results: Four medical, four surgical wards and two ICUs were included in the study, for a total of 35,921 patient days. Among the medical wards we observed after the interruption a significant increase in fluoroquinolone use, with a change in trend (CT) of 0.996, p = 0.027. In the surgical wards, we observed a significant increase in the overall consumption, with a change in level (CL) of 24.4, p = 0.005, and in the use of third and fourth generation cephalosporins (CL 4.7, p = 0.003). In two ICUs, we observed a significant increase in piperacillin/tazobactam and fluoroquinolone consumption (CT 9.28, p = 0.019, and 2.4, p = 0.047). In the wards with a duration of ASP less than 30 months, we observed a significant increase in antibiotic consumption in the use of piperacillin/tazobactam and fluoroquinolones (CT 12.9, p = 0.022: 4.12, p = 0.029; 1.004, p = 0.011). Conclusions: The interruption of ASP during COVID-19 led to an increase in the consumption of broad-spectrum antibiotics, particularly in surgical wards and in those with a duration of ASP less than 30 months.
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Marchetti F, Prato R, Viale P. Survey among Italian experts on existing vaccines' role in limiting antibiotic resistance. Hum Vaccin Immunother 2021; 17:4283-4290. [PMID: 34591738 PMCID: PMC8828092 DOI: 10.1080/21645515.2021.1969853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/13/2021] [Indexed: 12/20/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major public health problem threatening to reverse the progress made against infectious diseases. The rapid increase of AMR exposes Italian hospitals at increased risk of untreatable infections. Vaccinations can potentially limit AMR by reducing the number of infected cases in need of antibiotics. We conducted a survey among Italian vaccine experts to record their opinion regarding the role of vaccinations against antibiotic resistance (ABR). Among 80 invited experts, 51 answered all questions. Most respondents were experts in hygiene and preventive medicine (56.9%) and aged >50 years (72.6%). ABR was a priority concern in the daily professional activity of 82.4% of respondents. Overall, 47.1% of respondents believed that all vaccinations included in the vaccination calendar played a role against ABR: 92.2% for pertussis vaccination followed by 88.2%, 74.5%, and 70.6% for meningococcus, measles, and varicella vaccinations, respectively. Almost all respondents agreed that the role of vaccinations against ABR should be clearly expressed in the national vaccination guidelines (96.1%) and Scientific Societies should take an explicit position on the issue (92.2%). These results show that Italian experts have recognized the vaccinations' potential role in limiting ABR and guidelines from the appropriate scientific and governmental authorities are needed.
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Affiliation(s)
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Department of Hygiene, Policlinico Riuniti University Hospital of Foggia, Foggia, Italy
| | - Pierluigi Viale
- IRCCS Policlinico Sant’Orsola, Infectious Disease Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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80
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Coenen S, de la Court JR, Buis DTP, Meijboom LJ, Schade RP, Visser CE, van Hest R, Kuijvenhoven M, Prins JM, Nijman SFM, Sieswerda E, Sigaloff KCE. Low frequency of community-acquired bacterial co-infection in patients hospitalized for COVID-19 based on clinical, radiological and microbiological criteria: a retrospective cohort study. Antimicrob Resist Infect Control 2021; 10:155. [PMID: 34717761 PMCID: PMC8556861 DOI: 10.1186/s13756-021-01024-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We defined the frequency of respiratory community-acquired bacterial co-infection in patients with COVID-19, i.e. patients with a positive SARS-CoV-2 PCR or a COVID-19 Reporting and Data System (CO-RADS) score ≥ 4, based on a complete clinical assessment, including prior antibiotic use, clinical characteristics, inflammatory markers, chest computed tomography (CT) results and microbiological test results. METHODS Our retrospective study was conducted within a cohort of prospectively included patients admitted for COVID-19 in our tertiary medical centres between 1-3-2020 and 1-6-2020. A multidisciplinary study team developed a diagnostic protocol to retrospectively categorize patients as unlikely, possible or probable bacterial co-infection based on clinical, radiological and microbiological parameters in the first 72 h of admission. Within the three categories, we summarized patient characteristics and antibiotic consumption. RESULTS Among 281 included COVID-19 patients, bacterial co-infection was classified as unlikely in 233 patients (82.9%), possible in 35 patients (12.4%) and probable in 3 patients (1.1%). Ten patients (3.6%) could not be classified due to inconclusive data. Within 72 h of hospital admission, 81% of the total study population and 78% of patients classified as unlikely bacterial co-infection received antibiotics. CONCLUSIONS COVID-19 patients are unlikely to have a respiratory community-acquired bacterial co-infection. This study underpins recommendations for restrictive use of antibacterial drugs in patients with COVID-19.
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Affiliation(s)
- Sophie Coenen
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jara R de la Court
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - David T P Buis
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Caroline E Visser
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Reinier van Hest
- Department of Clinical Pharmacy and Pharmacology, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marianne Kuijvenhoven
- Department of Clinical Pharmacy and Pharmacology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Suzan F M Nijman
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elske Sieswerda
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Univ of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kim C E Sigaloff
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
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Amarsy R, Trystram D, Cambau E, Monteil C, Fournier S, Oliary J, Junot H, Sabatier P, Porcher R, Robert J, Jarlier V. Surging bloodstream infections and antimicrobial resistance during the first wave of COVID-19: a study in a large multihospital institution in the Paris region. Int J Infect Dis 2021; 114:90-96. [PMID: 34688945 PMCID: PMC8531236 DOI: 10.1016/j.ijid.2021.10.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/22/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives This study measured the impact of the first wave of COVID-19 pandemic (COVID-19) (March–April 2020) on the incidence of bloodstream infections (BSIs) at Assistance Publique – Hôpitaux de Paris (APHP), the largest multisite public healthcare institution in France. Methods The number of patient admission blood cultures (BCs) collected, number of positive BCs, and antibiotic resistance and consumption were analysed retrospectively for the first quarter of 2020, and also for the first quarter of 2019 for comparison, in 25 APHP hospitals (ca. 14 000 beds). Results Up to a fourth of patients admitted in March–April 2020 in these hospitals had COVID-19. The BSI rate per 100 admissions increased overall by 24% in March 2020 and 115% in April 2020, and separately for the major pathogens (Escherichia coli, Klebsiella pneumoniae, enterococci, Staphylococcus aureus, Pseudomonas aeruginosa, yeasts). A sharp increase in the rate of BSIs caused by microorganisms resistant to third-generation cephalosporins (3GC) was also observed in March–April 2020, particularly in K. pneumoniae, enterobacterial species naturally producing inducible AmpC (Enterobacter cloacae...), and P. aeruginosa. A concomitant increase in 3GC consumption occurred. Conclusions The COVID-19 pandemic had a strong impact on hospital management and also unfavourable effects on severe infections, antimicrobial resistance, and laboratory work diagnostics.
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Affiliation(s)
- Rishma Amarsy
- Groupe hospitalo-universitaire APHP Nord-Université de Paris, Site Lariboisière et Fernand Widal, Infection Prevention and Control Team and CIMI-Paris, Inserm U1135, Sorbonne Université, Paris, France
| | - David Trystram
- Groupe hospitalo-universitaire APHP Sorbonne Université, Site Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Paris, France and Direction des Systèmes d'Information de l'Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emmanuelle Cambau
- Groupe hospitalo-universitaire APHP Nord -Université de Paris, Site Lariboisière, Laboratoire de Microbiologie-Hygiène and Inserm UMR1137 IAME, Paris, France
| | - Catherine Monteil
- Central Infection Control Team, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Sandra Fournier
- Central Infection Control Team, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Juliette Oliary
- Groupe hospitalo-universitaire APHP Nord-Université de Paris, Site Lariboisière, Pharmacie, Paris, France
| | - Helga Junot
- Groupe hospitalo-universitaire APHP Sorbonne Université, Site Pitié-Salpêtrière, Pharmacie, Paris, France
| | - Pierre Sabatier
- Agence Générale des Equipements et Produits de Santé, Assistance Publique - Hôpitaux de Paris, Pharmacie, Paris, France
| | - Raphaël Porcher
- Groupe hospitalo-universitaire APHP Centre-Université de Paris, Site Hôtel-Dieu, Centre for Clinical Epidemiology, Paris, France; Université de Paris, CRESS UMR1153, INSERM, INRAE, Paris, France
| | - Jérôme Robert
- Groupe hospitalo-universitaire APHP Sorbonne Université, Site Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène and CIMI-Paris, Inserm U1135, Sorbonne Université, Paris, France
| | - Vincent Jarlier
- Groupe hospitalo-universitaire APHP Sorbonne Université, Site Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène and CIMI-Paris, Inserm U1135, Sorbonne Université, Paris, France.
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82
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Tomczyk S, Taylor A, Brown A, de Kraker MEA, El-Saed A, Alshamrani M, Hendriksen RS, Jacob M, Löfmark S, Perovic O, Shetty N, Sievert D, Smith R, Stelling J, Thakur S, Vietor AC, Eckmanns T. Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey. J Antimicrob Chemother 2021; 76:3045-3058. [PMID: 34473285 PMCID: PMC8499888 DOI: 10.1093/jac/dkab300] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. METHODS From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed. RESULTS Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. CONCLUSIONS This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.
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Affiliation(s)
- Sara Tomczyk
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Angelina Taylor
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Allison Brown
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - Marlieke E A de Kraker
- Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety, Geneva, Switzerland
| | - Aiman El-Saed
- King Abdulaziz Medical City, WHO Collaborating Centre for Infection Prevention and Control and Anti-Microbial, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- King Abdulaziz Medical City, WHO Collaborating Centre for Infection Prevention and Control and Anti-Microbial, Riyadh, Saudi Arabia
| | - Rene S Hendriksen
- Technical University of Denmark, National Food Institute, WHO Collaborating Centre for Antimicrobial Resistance in Foodborne Pathogens and Genomics, Kongens Lyngby, Denmark
| | - Megan Jacob
- College of Veterinary Medicine, North Carolina State University, WHO Collaborating Centre for Global One Health and Antimicrobial Resistance Initiatives, Raleigh, NC, USA
| | - Sonja Löfmark
- Public Health Agency of Sweden, WHO Collaborating Centre for Antimicrobial Resistance Containment, Stockholm, Sweden
| | - Olga Perovic
- National Institute for Communicable Diseases and School of Pathology at University of Witwatersrand, WHO Collaborating Centre for Antimicrobial Resistance, Johannesburg, South Africa
| | - Nandini Shetty
- National Infection Service Laboratories, Public Health England, WHO Collaborating Centre for Reference & Research on Antimicrobial Resistance and Healthcare Associated Infections, London, UK
| | - Dawn Sievert
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - Rachel Smith
- Centers for Disease Control and Prevention, WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents, Atlanta, GA, USA
| | - John Stelling
- Brigham and Women’s Hospital, WHO Collaborating Centre for Surveillance of Antimicrobial Resistance, Boston, MA, USA
| | - Siddhartha Thakur
- College of Veterinary Medicine, North Carolina State University, WHO Collaborating Centre for Global One Health and Antimicrobial Resistance Initiatives, Raleigh, NC, USA
| | - Ann Christin Vietor
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany
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83
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Son HJ, Kim T, Lee E, Park SY, Yu S, Hong HL, Kim MC, Hong SI, Bae S, Kim MJ, Kim SH, Yun JH, Jo KM, Lee YM, Lee S, Park JW, Jeon MH, Kim TH, Choo EJ. Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study. Am J Infect Control 2021; 49:1256-1261. [PMID: 34146624 PMCID: PMC8251653 DOI: 10.1016/j.ajic.2021.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/01/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
Objectives Superimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment. Methods All eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated. Results Of 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (5 isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (4 isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% vs 15%; P = .001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; P = .004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; P = .048) were associated with MDRO isolation. Conclusions MDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors.
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Affiliation(s)
- Hyo-Ju Son
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Shinae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyo-Lim Hong
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Min-Chul Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Sun In Hong
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Hyun Yun
- Department of Infectious Diseases, Konkuk University Medical Center, Konkuk University School of Medicine
| | - Kyeong Min Jo
- Division of Infectious Disease, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Yu-Mi Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seungjae Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Wan Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Min Hyok Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
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Impact of the COVID-19 pandemic on the surveillance of antimicrobial resistance. J Hosp Infect 2021; 117:147-156. [PMID: 34562548 PMCID: PMC8457641 DOI: 10.1016/j.jhin.2021.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
Background The impact of the coronavirus disease (COVID-19) pandemic on antimicrobial resistance (AMR) is a major concern. Aim To compare the number of patients and isolation rate of antimicrobial-resistant bacteria before and after the beginning of the COVID-19 pandemic using the comprehensive national surveillance data. Methods We utilized comprehensive surveillance data, collected in the Japan Nosocomial Infections Surveillance programme, which included a total of 16.7 million samples of 5.9 million tested patients from >1300 hospitals. We compared the number of patients and isolation rate of five bacteria between 2019 and 2020, including antimicrobial-susceptible and -resistant bacteria of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Findings The number of patients and isolation rate of S. aureus and meticillin-resistant S. aureus decreased slightly; those of S. pneumoniae and penicillin-resistant S. pneumoniae decreased by 60%; and those of third-generation cephalosporin-resistant K. pneumoniae increased. The isolation rate of the remaining bacteria apparently increased, although the number of patients decreased. This was due to a substantial decrease in the total number of tested patients (the denominator of the isolation rate), which was larger than that of the number of patients (the numerator of the isolation rate). Consistent results were obtained when the same data were re-aggregated using the procedure of the World Health Organization Global Antimicrobial Resistance Surveillance System, demonstrating the general importance of this problem. Conclusion Surveillance data during the COVID-19 pandemic must be carefully interpreted based on examination of the numerator, denominator and background factors that affect the denominator.
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85
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Polemis M, Mandilara G, Pappa O, Argyropoulou A, Perivolioti E, Koudoumnakis N, Pournaras S, Vasilakopoulou A, Vourli S, Katsifa H, Karampatakis T, Papavasiliou A, Petinaki E, Xitsas S, Skoura L, Protonotariou E, Mantzana P, Gartzonika K, Priavali E, Kallinteri A, Giannopoulou P, Charalampaki N, Memezas M, Calina Oana Z, Papadogianni M, Panopoulou M, Koutsidou A, Vatopoulos A, Tryfinopoulou K. COVID-19 and Antimicrobial Resistance: Data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance-WHONET-Greece (January 2018-March 2021). Life (Basel) 2021; 11:996. [PMID: 34685368 PMCID: PMC8538738 DOI: 10.3390/life11100996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 12/15/2022] Open
Abstract
Changes in hospitals' daily practice due to COVID-19 pandemic may have an impact on antimicrobial resistance (AMR). We aimed to assess this possible impact as captured by the Greek Electronic System for the Surveillance of Antimicrobial Resistance (WHONET-Greece). Routine susceptibility data of 17,837 Gram-negative and Gram-positive bacterial isolates from blood and respiratory specimens of hospitalized patients in nine COVID-19 tertiary hospitals were used in order to identify potential differences in AMR trends in the last three years, divided into two periods, January 2018-March 2020 and April 2020-March 2021. Interrupted time-series analysis was used to evaluate differences in the trends of non-susceptibility before and after the changes due to COVID-19. We found significant differences in the slope of non-susceptibility trends of Acinetobacter baumannii blood and respiratory isolates to amikacin, tigecycline and colistin; of Klebsiella pneumoniae blood and respiratory isolates to meropenem and tigecycline; and of Pseudomonas aeruginosa respiratory isolates to imipenem, meropenem and levofloxacin. Additionally, we found significant differences in the slope of non-susceptibility trends of Staphylococcus aureus isolates to oxacillin and of Enterococcus faecium isolates to glycopeptides. Assessing in this early stage, through surveillance of routine laboratory data, the way a new global threat like COVID-19 could affect an already ongoing pandemic like AMR provides useful information for prompt action.
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Affiliation(s)
- Michalis Polemis
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
| | - Georgia Mandilara
- School of Public Health, University of West Attica, 11521 Athens, Greece; (G.M.); (A.V.)
| | - Olga Pappa
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
| | - Athina Argyropoulou
- “Evaggelismos” General Hospital, 10676 Athens, Greece; (A.A.); (E.P.); (N.K.)
| | | | | | - Spyros Pournaras
- “Attikon” University Hospital, 12462 Athens, Greece; (S.P.); (A.V.); (S.V.)
| | | | - Sophia Vourli
- “Attikon” University Hospital, 12462 Athens, Greece; (S.P.); (A.V.); (S.V.)
| | - Helen Katsifa
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Theodoros Karampatakis
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Anastasia Papavasiliou
- General Hospital “George Papanikolaou”, 57010 Thessaloniki, Greece; (H.K.); (T.K.); (A.P.)
| | - Efthymia Petinaki
- University Hospital of Larissa, 41110 Larissa, Greece; (E.P.); (S.X.)
| | - Stylianos Xitsas
- University Hospital of Larissa, 41110 Larissa, Greece; (E.P.); (S.X.)
| | - Lemonia Skoura
- “Axepa” University Hospital, 54636 Thessaloniki, Greece; (L.S.); (E.P.); (P.M.)
| | | | - Paraskevi Mantzana
- “Axepa” University Hospital, 54636 Thessaloniki, Greece; (L.S.); (E.P.); (P.M.)
| | | | - Efthalia Priavali
- University Hospital of Ioannina, 45500 Ioannina, Greece; (K.G.); (E.P.); (A.K.)
| | - Amalia Kallinteri
- University Hospital of Ioannina, 45500 Ioannina, Greece; (K.G.); (E.P.); (A.K.)
| | | | | | - Meletis Memezas
- “Thriasio” General Hospital of Elefsina, 19600 Athens, Greece; (P.G.); (N.C.); (M.M.)
| | - Zervaki Calina Oana
- “St. George” General Hospital, 73300 Crete (Chania), Greece; (Z.C.O.); (M.P.)
| | - Marina Papadogianni
- “St. George” General Hospital, 73300 Crete (Chania), Greece; (Z.C.O.); (M.P.)
| | - Maria Panopoulou
- University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece; (M.P.); (A.K.)
| | - Athanasia Koutsidou
- University Hospital of Alexandroupolis, 68100 Alexandroupoli, Greece; (M.P.); (A.K.)
| | - Alkiviadis Vatopoulos
- School of Public Health, University of West Attica, 11521 Athens, Greece; (G.M.); (A.V.)
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece; (O.P.); (K.T.)
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Ryu S, Hwang Y, Ali ST, Kim DS, Klein EY, Lau EHY, Cowling BJ. Decreased Use of Broad-Spectrum Antibiotics During the Coronavirus Disease 2019 Epidemic in South Korea. J Infect Dis 2021; 224:949-955. [PMID: 33856455 PMCID: PMC8083342 DOI: 10.1093/infdis/jiab208] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Early in the coronavirus disease 2019 (COVID-19) pandemic, there was a concern over possible increase in antibiotic use due to coinfections among COVID-19 patients in the community. Here, we evaluate the changes in nationwide use of broad-spectrum antibiotics during the COVID-19 epidemic in South Korea. METHODS We obtained national reimbursement data on the prescription of antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, fluoroquinolones, and macrolides. We examined the number of antibiotic prescriptions compared with the previous 3 years in the same period from August to July. To quantify the impact of the COVID-19 epidemic on antibiotic use, we developed a regression model adjusting for changes of viral acute respiratory tract infections (ARTIs), which are an important factor driving antibiotic use. RESULTS During the COVID-19 epidemic in South Korea, the broad-spectrum antibiotic use dropped by 15%-55% compared to the previous 3 years. Overall reduction in antibiotic use adjusting for ARTIs was estimated to be 14%-30%, with a larger impact in children. CONCLUSIONS Our study found that broad-spectrum antibiotic use was substantially reduced during the COVID-19 epidemic in South Korea. This reduction can be in part due to reduced ARTIs as a result of stringent public health interventions including social distancing measures.
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Affiliation(s)
- Sukhyun Ryu
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Youngsik Hwang
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sheikh Taslim Ali
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Dong-Sook Kim
- Pharmaceutical and Medical Technology Research Team, Department of Research, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Eili Y Klein
- Center for Disease Dynamics, Economics and Policy, Washington, District of Columbia, USA
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Eric H Y Lau
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
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87
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Silva TM, Estrela M, Gomes ER, Piñeiro-Lamas M, Figueiras A, Roque F, Herdeiro MT. The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach. Antibiotics (Basel) 2021; 10:1040. [PMID: 34572622 PMCID: PMC8465975 DOI: 10.3390/antibiotics10091040] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.
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Affiliation(s)
- Tânia Magalhães Silva
- Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3810 Aveiro, Portugal; (M.E.); (M.T.H.)
| | - Marta Estrela
- Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3810 Aveiro, Portugal; (M.E.); (M.T.H.)
| | - Eva Rebelo Gomes
- Allergy and Clinical Immunology Service, University Hospital Center of Porto, 4099 Porto, Portugal;
| | - Maria Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health—CIBERESP), 15706 Santiago de Compostela, Spain;
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health—CIBERESP), 15706 Santiago de Compostela, Spain;
- Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Fátima Roque
- Research Unit for Inland Development, Guarda Polytechnic Institute (UDI-IPG), 6300 Guarda, Portugal;
- Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200 Covilhã, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, iBiMED—Institute of Biomedicine, University of Aveiro, 3810 Aveiro, Portugal; (M.E.); (M.T.H.)
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The Pandemic beyond the Pandemic: A Scoping Review on the Social Relationships between COVID-19 and Antimicrobial Resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168766. [PMID: 34444511 PMCID: PMC8391257 DOI: 10.3390/ijerph18168766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/23/2022]
Abstract
The social sciences are essential to include in the fight against both public health challenges of antimicrobial resistance (AMR) and COVID-19. In this scoping review, we document what social science knowledge has been published about the social relationship between COVID-19 and AMR and which social science interventions are suggested to address this social relationship. We analysed 23 peer-reviewed articles published between 2019 and 2021. Results emphasize that changes in antibiotic prescription behaviour, misinformation, over-burdened health systems, financial hardship, environmental impact and gaps in governance might increase the improper access and use of antibiotics during the COVID-19 pandemic, increasing AMR. The identified social sciences transformation strategies include social engagement and sensitisation, misinformation control, health systems strengthening, improved infection prevention and control measures, environmental protection, and better antimicrobial stewardship and infectious diseases governance. The review emphasizes the importance of interdisciplinary research in addressing both AMR and COVID-19.
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Sousa SA, Feliciano JR, Pita T, Soeiro CF, Mendes BL, Alves LG, Leitão JH. Bacterial Nosocomial Infections: Multidrug Resistance as a Trigger for the Development of Novel Antimicrobials. Antibiotics (Basel) 2021; 10:antibiotics10080942. [PMID: 34438992 PMCID: PMC8389044 DOI: 10.3390/antibiotics10080942] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/23/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Nosocomial bacterial infections are associated with high morbidity and mortality, posing a huge burden to healthcare systems worldwide. The ongoing COVID-19 pandemic, with the raised hospitalization of patients and the increased use of antimicrobial agents, boosted the emergence of difficult-to-treat multidrug-resistant (MDR) bacteria in hospital settings. Therefore, current available antibiotic treatments often have limited or no efficacy against nosocomial bacterial infections, and novel therapeutic approaches need to be considered. In this review, we analyze current antibacterial alternatives under investigation, focusing on metal-based complexes, antimicrobial peptides, and antisense antimicrobial therapeutics. The association of new compounds with older, commercially available antibiotics and the repurposing of existing drugs are also revised in this work.
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Affiliation(s)
- Sílvia A. Sousa
- Department of Bioengineering, IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; (J.R.F.); (T.P.); (C.F.S.); (B.L.M.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Correspondence: (S.A.S.); (J.H.L.); Tel.: +351-218417688 (J.H.L.)
| | - Joana R. Feliciano
- Department of Bioengineering, IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; (J.R.F.); (T.P.); (C.F.S.); (B.L.M.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Tiago Pita
- Department of Bioengineering, IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; (J.R.F.); (T.P.); (C.F.S.); (B.L.M.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Catarina F. Soeiro
- Department of Bioengineering, IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; (J.R.F.); (T.P.); (C.F.S.); (B.L.M.)
| | - Beatriz L. Mendes
- Department of Bioengineering, IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; (J.R.F.); (T.P.); (C.F.S.); (B.L.M.)
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisboa, Portugal
| | - Luis G. Alves
- Centro de Química Estrutural, Associação do Instituto Superior Técnico para a Investigação e Desenvolvimento, 1049-003 Lisboa, Portugal;
| | - Jorge H. Leitão
- Department of Bioengineering, IBB-Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal; (J.R.F.); (T.P.); (C.F.S.); (B.L.M.)
- Associate Laboratory i4HB—Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
- Correspondence: (S.A.S.); (J.H.L.); Tel.: +351-218417688 (J.H.L.)
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Abstract
PURPOSE OF REVIEW The coronavirus disease (COVID-19) pandemic has resulted in necessary modifications of infection control policies and practices in acute healthcare facilities globally. This is often accompanied by infrastructure modifications, ward redesignations, as well as healthcare staff redeployments and changes to infection prevention and control (IPC) practices. We review the potential for both negative and positive impacts these major changes can have on nosocomial transmission of multidrug-resistant organisms (MDROs). RECENT FINDINGS Healthcare facilities around the world have reported outbreaks of MDROs during the COVID-19 pandemic. In contrast some centres have reported a decrease in baseline rates due to a number of possible factors. SUMMARY While implementing crucial preventive measures for COVID-19, is it important to consider any collateral effects of changes in IPC and antimicrobial stewardship program (ASP) practices. The disruption caused to IPC and ASP practices during the pandemic are likely to see a counter intuitive increase in transmission of MDROs.
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91
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Amplicon and Metagenomic Analysis of Middle East Respiratory Syndrome (MERS) Coronavirus and the Microbiome in Patients with Severe MERS. mSphere 2021; 6:e0021921. [PMID: 34287009 PMCID: PMC8386452 DOI: 10.1128/msphere.00219-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic infection that emerged in the Middle East in 2012. Symptoms range from mild to severe and include both respiratory and gastrointestinal illnesses. The virus is mainly present in camel populations with occasional zoonotic spill over into humans. The severity of infection in humans is influenced by numerous factors, and similar to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), underlying health complications can play a major role. Currently, MERS-CoV and SARS-CoV-2 are coincident in the Middle East and thus a rapid way of sequencing MERS-CoV to derive genotype information for molecular epidemiology is needed. Additionally, complicating factors in MERS-CoV infections are coinfections that require clinical management. The ability to rapidly characterize these infections would be advantageous. To rapidly sequence MERS-CoV, an amplicon-based approach was developed and coupled to Oxford Nanopore long read length sequencing. This and a metagenomic approach were evaluated with clinical samples from patients with MERS. The data illustrated that whole-genome or near-whole-genome information on MERS-CoV could be rapidly obtained. This approach provided data on both consensus genomes and the presence of minor variants, including deletion mutants. The metagenomic analysis provided information of the background microbiome. The advantage of this approach is that insertions and deletions can be identified, which are the major drivers of genotype change in coronaviruses. IMPORTANCE Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in late 2012 in Saudi Arabia. The virus is a serious threat to people not only in the Middle East but also in the world and has been detected in over 27 countries. MERS-CoV is spreading in the Middle East and neighboring countries, and approximately 35% of reported patients with this virus have died. This is the most severe coronavirus infection so far described. Saudi Arabia is a destination for many millions of people in the world who visit for religious purposes (Umrah and Hajj), and so it is a very vulnerable area, which imposes unique challenges for effective control of this epidemic. The significance of our study is that clinical samples from patients with MERS were used for rapid in-depth sequencing and metagenomic analysis using long read length sequencing.
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92
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Kumaravel V, Nair KM, Mathew S, Bartlett J, Kennedy JE, Manning HG, Whelan BJ, Leyland NS, Pillai SC. Antimicrobial TiO 2 nanocomposite coatings for surfaces, dental and orthopaedic implants. CHEMICAL ENGINEERING JOURNAL (LAUSANNE, SWITZERLAND : 1996) 2021; 416:129071. [PMID: 33642937 PMCID: PMC7899925 DOI: 10.1016/j.cej.2021.129071] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 05/03/2023]
Abstract
Engineering of self-disinfecting surfaces to constrain the spread of SARS-CoV-2 is a challenging task for the scientific community because the human coronavirus spreads through respiratory droplets. Titania (TiO2) nanocomposite antimicrobial coatings is one of the ideal remedies to disinfect pathogens (virus, bacteria, fungi) from common surfaces under light illumination. The photocatalytic disinfection efficiency of recent TiO2 nanocomposite antimicrobial coatings for surfaces, dental and orthopaedic implants are emphasized in this review. Mostly, inorganic metals (e.g. copper (Cu), silver (Ag), manganese (Mn), etc), non-metals (e.g. fluorine (F), calcium (Ca), phosphorus (P)) and two-dimensional materials (e.g. MXenes, MOF, graphdiyne) were incorporated with TiO2 to regulate the charge transfer mechanism, surface porosity, crystallinity, and the microbial disinfection efficiency. The antimicrobial activity of TiO2 coatings was evaluated against the most crucial pathogenic microbes such as Escherichia coli, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, Legionella pneumophila, Staphylococcus aureus, Streptococcus mutans, T2 bacteriophage, H1N1, HCoV-NL63, vesicular stomatitis virus, bovine coronavirus. Silane functionalizing agents and polymers were used to coat the titanium (Ti) metal implants to introduce superhydrophobic features to avoid microbial adhesion. TiO2 nanocomposite coatings in dental and orthopaedic metal implants disclosed exceptional bio-corrosion resistance, durability, biocompatibility, bone-formation capability, and long-term antimicrobial efficiency. Moreover, the commercial trend, techno-economics, challenges, and prospects of antimicrobial nanocomposite coatings are also discussed briefly.
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Affiliation(s)
- Vignesh Kumaravel
- Nanotechnology and Bio-Engineering Research Group, Department of Environmental Science, School of Science, Institute of Technology Sligo, Ash Lane, Sligo, Ireland
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology Sligo, Ash Lane, Sligo, Ireland
| | - Keerthi M Nair
- Nanotechnology and Bio-Engineering Research Group, Department of Environmental Science, School of Science, Institute of Technology Sligo, Ash Lane, Sligo, Ireland
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology Sligo, Ash Lane, Sligo, Ireland
| | - Snehamol Mathew
- Nanotechnology and Bio-Engineering Research Group, Department of Environmental Science, School of Science, Institute of Technology Sligo, Ash Lane, Sligo, Ireland
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology Sligo, Ash Lane, Sligo, Ireland
| | - John Bartlett
- Nanotechnology and Bio-Engineering Research Group, Department of Environmental Science, School of Science, Institute of Technology Sligo, Ash Lane, Sligo, Ireland
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology Sligo, Ash Lane, Sligo, Ireland
| | | | | | | | | | - Suresh C Pillai
- Nanotechnology and Bio-Engineering Research Group, Department of Environmental Science, School of Science, Institute of Technology Sligo, Ash Lane, Sligo, Ireland
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Institute of Technology Sligo, Ash Lane, Sligo, Ireland
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Andrews A, Budd EL, Hendrick A, Ashiru-Oredope D, Beech E, Hopkins S, Gerver S, Muller-Pebody B. Surveillance of Antibacterial Usage during the COVID-19 Pandemic in England, 2020. Antibiotics (Basel) 2021; 10:841. [PMID: 34356762 PMCID: PMC8300678 DOI: 10.3390/antibiotics10070841] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/19/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Changes in antibacterial prescribing during the COVID-19 pandemic were anticipated given that the clinical features of severe respiratory infection syndrome caused by SARS-CoV-2 mirror bacterial respiratory tract infections. Antibacterial consumption was measured in items/1000 population for primary care and in Defined Daily Doses (DDDs)/1000 admissions for secondary care in England from 2015 to October 2020. Interrupted time-series analyses were conducted to evaluate the effects of the pandemic on antibacterial consumption. In the community, the rate of antibacterial items prescribed decreased further in 2020 (by an extra 1.4% per month, 95% CI: -2.3 to -0.5) compared to before COVID-19. In hospitals, the volume of antibacterial use decreased during COVID-19 overall (-12.1% compared to pre-COVID, 95% CI: -19.1 to -4.4), although the rate of usage in hospitals increased steeply in April 2020. Use of antibacterials prescribed for respiratory infections and broad-spectrum antibacterials (predominately 'Watch' antibacterials in hospitals) increased in both settings. Overall volumes of antibacterial use at the beginning of the COVID-19 pandemic decreased in both primary and secondary settings, although there were increases in the rate of usage in hospitals in April 2020 and in specific antibacterials. This highlights the importance of antimicrobial stewardship during pandemics to ensure appropriate prescribing and avoid negative consequences on patient outcomes and antimicrobial resistance.
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Affiliation(s)
- Amelia Andrews
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Emma L. Budd
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
| | - Aoife Hendrick
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
| | - Diane Ashiru-Oredope
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | | | - Susan Hopkins
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Sarah Gerver
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Berit Muller-Pebody
- Healthcare-Associated Infection and Antimicrobial Resistance Division, Public Health England, London NW9 5EQ, UK; (E.L.B.); (A.H.); (D.A.-O.); (S.H.); (S.G.); (B.M.-P.)
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford OX3 9DU, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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Kerr F, Sefah IA, Essah DO, Cockburn A, Afriyie D, Mahungu J, Mirfenderesky M, Ankrah D, Aggor A, Barrett S, Brayson J, Muro E, Benedict P, Santos R, Kanturegye R, Onegwa R, Sekikubo M, Rees F, Banda D, Kalungia AC, Alutuli L, Chikatula E, Ashiru-Oredope D. Practical Pharmacist-Led Interventions to Improve Antimicrobial Stewardship in Ghana, Tanzania, Uganda and Zambia. PHARMACY 2021; 9:pharmacy9030124. [PMID: 34287350 PMCID: PMC8293468 DOI: 10.3390/pharmacy9030124] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 12/27/2022] Open
Abstract
The World Health Organisation (WHO) and others have identified, as a priority, the need to improve antimicrobial stewardship (AMS) interventions as part of the effort to tackle antimicrobial resistance (AMR). An international health partnership model, the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme, was established between selected countries in Africa (Ghana, Tanzania, Zambia and Uganda) and the UK to support AMS. This was funded by UK aid under the Fleming Fund and managed by the Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET). The primary aims were to develop local AMS teams and generate antimicrobial consumption surveillance data, quality improvement initiatives, infection prevention and control (IPC) and education/training to reduce AMR. Education and training were key components in achieving this, with pharmacists taking a lead role in developing and leading AMS interventions. Pharmacist-led interventions in Ghana improved access to national antimicrobial prescribing guidelines via the CwPAMS mobile app and improved compliance with policy from 18% to 70% initially for patients with pneumonia in one outpatient clinic. Capacity development on AMS and IPC were achieved in both Tanzania and Zambia, and a train-the-trainer model on the local production of alcohol hand rub in Uganda and Zambia. The model of pharmacy health partnerships has been identified as a model with great potential to be used in other low and middle income countries (LMICs) to support tackling AMR.
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Affiliation(s)
- Frances Kerr
- Pharmacy, NHS Lanarkshire C/O Monklands Hospital, Airdrie ML6 0JS, UK;
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Keta P.O. Box WT 82, Ghana; (I.A.S.); (D.O.E.)
| | - Darius Obeng Essah
- Pharmacy Department, Keta Municipal Hospital, Keta P.O. Box WT 82, Ghana; (I.A.S.); (D.O.E.)
| | | | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra P.O. Box CT104, Ghana;
| | - Joyce Mahungu
- Pharmacy, North Middlesex University Hospital NHS Trust (NMUH), London N18 1QX, UK;
| | - Mariyam Mirfenderesky
- Microbiology, North Middlesex University Hospital NHS Trust (NMUH), London N18 1QX, UK;
| | - Daniel Ankrah
- Pharmacy Department, Korle-Bu Teaching Hospital (KBTH), Accra P.O. Box 77, Ghana; (D.A.); (A.A.)
| | - Asiwome Aggor
- Pharmacy Department, Korle-Bu Teaching Hospital (KBTH), Accra P.O. Box 77, Ghana; (D.A.); (A.A.)
| | - Scott Barrett
- Pharmacy, Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK; (S.B.); (J.B.)
| | - Joseph Brayson
- Pharmacy, Northumbria Healthcare NHS Foundation Trust, North Shields NE29 8NH, UK; (S.B.); (J.B.)
| | - Eva Muro
- Pharmacy Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi P.O. Box 3010, Tanzania; (E.M.); (P.B.)
| | - Peter Benedict
- Pharmacy Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi P.O. Box 3010, Tanzania; (E.M.); (P.B.)
| | - Reem Santos
- Pharmacy, Cambridge University Hospitals (CUH), NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Rose Kanturegye
- Pharmacy Department, Mulago Specialised Women and Neonatal Hospital Kawempe Hospital, Kampala P.O. Box 22081, Uganda; (R.K.); (R.O.)
| | - Ronald Onegwa
- Pharmacy Department, Mulago Specialised Women and Neonatal Hospital Kawempe Hospital, Kampala P.O. Box 22081, Uganda; (R.K.); (R.O.)
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, Makerere University and Mulago National Referral Hospital, Kampala P.O. Box 22081, Uganda;
| | - Fiona Rees
- Pharmacy, Brighton and Sussex University Hospitals NHS Trust (BSUH), Brighton, BN2 5BE, UK;
| | - David Banda
- Pharmacy Department, University Teaching Hospital (UTH), Lusaka P/Bag RW 1X, Zambia; (D.B.); (A.C.K.); (L.A.); (E.C.)
| | - Aubrey Chichonyi Kalungia
- Pharmacy Department, University Teaching Hospital (UTH), Lusaka P/Bag RW 1X, Zambia; (D.B.); (A.C.K.); (L.A.); (E.C.)
- Department of Pharmacy, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Luke Alutuli
- Pharmacy Department, University Teaching Hospital (UTH), Lusaka P/Bag RW 1X, Zambia; (D.B.); (A.C.K.); (L.A.); (E.C.)
| | - Enock Chikatula
- Pharmacy Department, University Teaching Hospital (UTH), Lusaka P/Bag RW 1X, Zambia; (D.B.); (A.C.K.); (L.A.); (E.C.)
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95
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Ullrich A, Schranz M, Rexroth U, Hamouda O, Schaade L, Diercke M, Boender TS. Impact of the COVID-19 pandemic and associated non-pharmaceutical interventions on other notifiable infectious diseases in Germany: An analysis of national surveillance data during week 1-2016 - week 32-2020. THE LANCET REGIONAL HEALTH. EUROPE 2021; 6:100103. [PMID: 34557831 PMCID: PMC8454829 DOI: 10.1016/j.lanepe.2021.100103] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic and associated non-pharmaceutical interventions (NPIs) affect healthcare seeking behaviour, access to healthcare, test strategies, disease notification and workload at public health authorities, but may also lead to a true change in transmission dynamics. We aimed to assess the impact of the pandemic and NPIs on other notifiable infectious diseases under surveillance in Germany. METHODS We included 32 nationally notifiable disease categories with case numbers >100/year in 2016-2019. We used quasi-Poisson regression analysis on a weekly aggregated time-series incorporating trend and seasonality, to compute the relative change in case numbers during week 2020-10 to 2020-32 (pandemic/NPIs), in comparison to week 2016-01 to 2020-09. FINDINGS During week 2020-10 to 2020-32, 216,825 COVID-19 cases, and 162,942 (-35%) cases of other diseases, were notified. Case numbers decreased across all ages and notification categories (all p<0•05), except for tick-borne encephalitis, which increased (+58%). The number of cases decreased most for respiratory diseases (from -86% for measles, to -12% for tuberculosis), gastro-intestinal diseases (from -83% for rotavirus gastroenteritis, to -7% for yersiniosis) and imported vector-borne diseases (-75% dengue fever, -73% malaria). The less affected infections were healthcare associated pathogens (from -43% infection/colonisation with carbapenem-non-susceptible Acinetobacter, to -28% for Methicillin-resistant Staphylococcus aureus invasive infection) and sexually transmitted and blood-borne diseases (from -28% for hepatitis B, to -12% for syphilis). INTERPRETATION During the COVID-19 pandemic a drastic decrease of notifications for most infectious diseases and pathogens was observed. Our findings suggest effects of NPIs on overall disease transmission that require further investigation. FUNDING The Robert Koch Institute is the National Public Health Institute of Germany, and is an institute within the portfolio of the Federal Ministry of Health.
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Affiliation(s)
- Alexander Ullrich
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Madlen Schranz
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Ute Rexroth
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Osamah Hamouda
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - Lars Schaade
- Robert Koch Institute, Centre for Biological Threats and Special Pathogens, Nordufer 20, 13353 Berlin, Germany
| | - Michaela Diercke
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
| | - T Sonia Boender
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Seestrasse 10, 13353 Berlin, Germany
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96
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Kukushkina EA, Hossain SI, Sportelli MC, Ditaranto N, Picca RA, Cioffi N. Ag-Based Synergistic Antimicrobial Composites. A Critical Review. NANOMATERIALS (BASEL, SWITZERLAND) 2021; 11:1687. [PMID: 34199123 PMCID: PMC8306300 DOI: 10.3390/nano11071687] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The emerging problem of the antibiotic resistance development and the consequences that the health, food and other sectors face stimulate researchers to find safe and effective alternative methods to fight antimicrobial resistance (AMR) and biofilm formation. One of the most promising and efficient groups of materials known for robust antimicrobial performance is noble metal nanoparticles. Notably, silver nanoparticles (AgNPs) have been already widely investigated and applied as antimicrobial agents. However, it has been proposed to create synergistic composites, because pathogens can find their way to develop resistance against metal nanophases; therefore, it could be important to strengthen and secure their antipathogen potency. These complex materials are comprised of individual components with intrinsic antimicrobial action against a wide range of pathogens. One part consists of inorganic AgNPs, and the other, of active organic molecules with pronounced germicidal effects: both phases complement each other, and the effect might just be the sum of the individual effects, or it can be reinforced by the simultaneous application. Many organic molecules have been proposed as potential candidates and successfully united with inorganic counterparts: polysaccharides, with chitosan being the most used component; phenols and organic acids; and peptides and other agents of animal and synthetic origin. In this review, we overview the available literature and critically discuss the findings, including the mechanisms of action, efficacy and application of the silver-based synergistic antimicrobial composites. Hence, we provide a structured summary of the current state of the research direction and give an opinion on perspectives on the development of hybrid Ag-based nanoantimicrobials (NAMs).
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Affiliation(s)
- Ekaterina A. Kukushkina
- Chemistry Department, University of Bari Aldo Moro, via Orabona 4, 70126 Bari, Italy; (E.A.K.); (S.I.H.); (M.C.S.); (N.D.); (R.A.P.)
- CSGI (Center for Colloid and Surface Science), Chemistry Department, University of Bari, via Orabona 4, 70126 Bari, Italy
| | - Syed Imdadul Hossain
- Chemistry Department, University of Bari Aldo Moro, via Orabona 4, 70126 Bari, Italy; (E.A.K.); (S.I.H.); (M.C.S.); (N.D.); (R.A.P.)
- CSGI (Center for Colloid and Surface Science), Chemistry Department, University of Bari, via Orabona 4, 70126 Bari, Italy
| | - Maria Chiara Sportelli
- Chemistry Department, University of Bari Aldo Moro, via Orabona 4, 70126 Bari, Italy; (E.A.K.); (S.I.H.); (M.C.S.); (N.D.); (R.A.P.)
- CSGI (Center for Colloid and Surface Science), Chemistry Department, University of Bari, via Orabona 4, 70126 Bari, Italy
| | - Nicoletta Ditaranto
- Chemistry Department, University of Bari Aldo Moro, via Orabona 4, 70126 Bari, Italy; (E.A.K.); (S.I.H.); (M.C.S.); (N.D.); (R.A.P.)
- CSGI (Center for Colloid and Surface Science), Chemistry Department, University of Bari, via Orabona 4, 70126 Bari, Italy
| | - Rosaria Anna Picca
- Chemistry Department, University of Bari Aldo Moro, via Orabona 4, 70126 Bari, Italy; (E.A.K.); (S.I.H.); (M.C.S.); (N.D.); (R.A.P.)
- CSGI (Center for Colloid and Surface Science), Chemistry Department, University of Bari, via Orabona 4, 70126 Bari, Italy
| | - Nicola Cioffi
- Chemistry Department, University of Bari Aldo Moro, via Orabona 4, 70126 Bari, Italy; (E.A.K.); (S.I.H.); (M.C.S.); (N.D.); (R.A.P.)
- CSGI (Center for Colloid and Surface Science), Chemistry Department, University of Bari, via Orabona 4, 70126 Bari, Italy
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97
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Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit. Infection 2021; 50:83-92. [PMID: 34176088 PMCID: PMC8236000 DOI: 10.1007/s15010-021-01643-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/15/2021] [Indexed: 02/08/2023]
Abstract
Objectives Superinfections in patients hospitalized in intensive care unit (ICU) are an important and challenging complication, also in COVID-19. However, no definitive data are available about the role of multidrug-resistant Acinetobacter baumannii (MDR-AB) in COVID-19. Methods This was a single-center, cross-sectional study including patients with MDR-AB infections admitted to ICU with or without COVID-19, between January 2019 and January 2021. The primary objective of the study was to evaluate risk factor for MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology. The secondary endpoints were 30-days mortality in all study population and risk factors associated with development of bloodstream infection (BSI). Results During the study period 32 adults with COVID-19 were enrolled and compared with 115 patients admitted in the same ICU for other reasons. We observed a total of 114 deaths, with a survival rate of 29.3%: 18.8% in COVID-19 and 32.2% in control group. Relative risk for MDR-AB infection in COVID-19 showed that serum lactate levels mmol/l > 2, Acinetobacter baumannii colonization, BSI and steroid therapy were observed more frequently in COVID-19 patients. Cox regression analysis showed that serum lactate levels > 2 mmol/l, Acinetobacter baumannii colonization, BSI, and steroid therapy were associated with 30-days mortality. Finally, patients with COVID-19, white blood cells count > 11,000 mm3, serum lactate levels > 2 mmol/l, infections at time of ICU admission, Acinetobacter baumannii colonization, and steroid therapy were independently associated with development of BSI. Conclusions Our data highlight the impact of BSI on outcome, the role of Acinetobacter baumannii colonization and the use of steroids on the risk to develop MDR-AB infections also during COVID-19.
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98
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Antimicrobial resistance and the COVID -19 pandemic: A double threat. Indian J Med Microbiol 2021; 39:401. [PMID: 34172324 PMCID: PMC8221041 DOI: 10.1016/j.ijmmb.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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99
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Al-Azzam S, Mhaidat NM, Banat HA, Alfaour M, Ahmad DS, Muller A, Al-Nuseirat A, Lattyak EA, Conway BR, Aldeyab MA. An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan. Antibiotics (Basel) 2021; 10:690. [PMID: 34207567 PMCID: PMC8229725 DOI: 10.3390/antibiotics10060690] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This study aimed at measuring changes and patterns of national antimicrobial use for one year preceding and one year during the COVID-19 pandemic. Annual national antimicrobial consumption for 2019 and 2020 was obtained from the Jordan Food and Drug Administration (JFDA) following the WHO surveillance methods. The WHO Access, Watch, and Reserve (AWaRe) classification was used. Total antibiotic consumption in 2020 (26.8 DDD per 1000 inhabitants per day) decreased by 5.5% compared to 2019 (28.4 DDD per 1000 inhabitants per day). There was an increase in the use of several antibiotics during 2020 compared with 2019 (third generation cephalosporins (19%), carbapenems (52%), macrolides (57%), and lincosamides (106%)). In 2020, there was a marked reduction in amoxicillin use (-53%), while the use of azithromycin increased by 74%. National antimicrobial consumption of the Access group decreased by 18% from 2019 to 2020 (59.1% vs. 48.1% of total consumption). The use of the Watch group increased in 2020 by 26%. The study highlighted an increase in the use of certain antibiotics during the pandemic period that are known to be associated with increasing resistance. Efforts to enhance national antimicrobial stewardship are needed to ensure rational use of antimicrobials.
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Affiliation(s)
- Sayer Al-Azzam
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.A.-A.); (N.M.M.)
| | - Nizar Mahmoud Mhaidat
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.A.-A.); (N.M.M.)
| | - Hayaa A. Banat
- Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; (H.A.B.); (M.A.); (D.S.A.)
| | - Mohammad Alfaour
- Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; (H.A.B.); (M.A.); (D.S.A.)
| | - Dana Samih Ahmad
- Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; (H.A.B.); (M.A.); (D.S.A.)
| | - Arno Muller
- Antimicrobial Resistance Division, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland;
| | - Adi Al-Nuseirat
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt;
| | | | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
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100
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Yock‐Corrales A, Lenzi J, Ulloa‐Gutiérrez R, Gómez‐Vargas J, Antúnez‐Montes OY, Rios Aida JA, Aguila O, Arteaga‐Menchaca E, Campos F, Uribe F, Parra Buitrago A, Maria Betancur Londoño L, Brizuela M, Buonsenso D. High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: A multinational experience in 990 cases from Latin America. Acta Paediatr 2021; 110:1902-1910. [PMID: 33742466 PMCID: PMC8251202 DOI: 10.1111/apa.15847] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
AIM This study aims to assess rates of antibiotic prescriptions and its determinants in in children with COVID-19 or Multisystem Inflammatory Syndrome (MIS-C). METHODS Children <18 years-old assessed in five Latin Americas countries with a diagnosis of COVID-19 or MIS-C were enrolled. Antibiotic prescriptions and factors associated with their use were assessed. RESULTS A total of 990 children were included: 921 (93%) with COVID-19, 69 (7.0%) with MIS-C. The prevalence of antibiotic use was 24.5% (n = 243). MIS-C with (OR = 45.48) or without (OR = 10.35) cardiac involvement, provision of intensive care (OR = 9.60), need for hospital care (OR = 6.87), pneumonia and/or ARDS detected through chest X-rays (OR = 4.40), administration of systemic corticosteroids (OR = 4.39), oxygen support, mechanical ventilation or CPAP (OR = 2.21), pyrexia (OR = 1.84), and female sex (OR = 1.50) were independently associated with increased use of antibiotics. There was significant variation in antibiotic use across the hospitals. CONCLUSION Our study showed a high rate of antibiotic prescriptions in children with COVID-19, in particular in those with severe disease or MIS-C. Prospective studies are needed to provide better evidence on the recognition and management of bacterial infections in COVID-19 children.
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Affiliation(s)
- Adriana Yock‐Corrales
- Pediatric Emergency Department CCSS Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" San José Costa Rica
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences Alma Mater Studiorum – University of Bologna Bologna Italy
| | - Rolando Ulloa‐Gutiérrez
- Infectious Disease Department CCSS Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" San José Costa Rica
| | - Jessica Gómez‐Vargas
- Pediatric Emergency Department CCSS Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera" San José Costa Rica
| | - Omar Yassef Antúnez‐Montes
- Departamento de Docencia e Investigación Instituto Latinoamericano de Ecografía en Medicina (ILEM Ciudad de Mexico Mexico
| | | | - Olguita Aguila
- Unidad de Infectología Pediátrica del Hospital Nacional Edgardo Rebagliati Martins Lima Peru
| | | | | | | | - Andrea Parra Buitrago
- Hospital Pablo Tobon Uribe Medellin Medellin Colombia
- Fundacion Neumologica Colombiana Bogotà Colombia
| | | | - Martin Brizuela
- Pediatric Infectious Disease Hospital isidoro Iriarte Quilmes Argentina
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health Fondazione Policlinico Universitario A. Gemelli Rome Italy
- Dipartimento di Scienze Biotecnologiche di Base Cliniche Intensivologiche e Perioperatorie Università Cattolica del Sacro Cuore Rome Italy
- Global Health Research Institute Istituto di Igiene Università Cattolica del Sacro Cuore Rome Italy
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