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Ahmed OB, Bahwerth FS, Alsafi R, Elsebaei EA, Ebid GT, Theyab A, Assaggaf H. The Prevalence and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Before and After the COVID-19 Pandemic in a Tertiary Saudi Hospital. Cureus 2024; 16:e54809. [PMID: 38529437 PMCID: PMC10962010 DOI: 10.7759/cureus.54809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has become a major public health problem all over the world. After the 2019 coronavirus illness (COVID-19), the pandemic may have influenced research priorities and resource allocation, potentially affecting the ability to monitor MRSA trends. AIMS The study aimed to evaluate the prevalence of S. aureus, including MRSA infections, and their antimicrobial susceptibilities over the years 2019 and 2020 in a tertiary hospital in Makkah City, KSA. METHODOLOGY A total of 2128 and 1515 laboratory (lab) samples were collected during the years 2019 and 2020, respectively. From these samples, the prevalence of S. aureus, including MRSA, and their antibiotic susceptibility were identified using standard, automated, and molecular microbiological methods. RESULTS The present study shows that the lab prevalence of all S. aureus during 2019 was found to be 35.5%, of which MRSA was 44.8%. During 2020, the frequency of S. aureus strains was 16%, of which MRSA was 41.2%. The most common MRSA isolated during both years were colonizing pus swabs and urine samples. The results showed that MRSA susceptibility against antimicrobial agents in 2019 was as follows: vancomycin (100%), linezolid (100%), trimethoprim-sulfamethoxazole (88%), and doxycycline (34.2%). The MRSA strains isolated during 2020 were as follows: vancomycin (100%), linezolid (96%), trimethoprim-sulfamethoxazole (100%), and doxycycline (24.3%). There was no significant difference in the incidence and antimicrobial resistance rates of MRSA over the two years. CONCLUSION It was concluded that the prevalence rates of MRSA have not increased in 2020 when compared to 2019. Vancomycin, linezolid, trimethoprim-sulfamethoxazole, and doxycycline remain susceptible to the positive collected MRSA strains. There was no significant difference between the prevalence and antimicrobial resistance rates of MRSA between 2019 and 2020. Continued research efforts are needed to address this persistent public health threat. Strategies to control the spread of MRSA should include early detection of MRSA and surveillance, even during pandemics.
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Affiliation(s)
- Omar B Ahmed
- Environmental and Health Research, Umm Al-Qura University, Makkah, SAU
| | | | - Radi Alsafi
- Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Eman A Elsebaei
- Medical Microbiology, Egypt Healthcare Authority, Cairo, EGY
| | - Gamal T Ebid
- Laboratory Medicine, Security Forces Hospital, Makkah, Makkah, SAU
- National Cancer Institute, Cairo University, Cairo, EGY
| | - Abdulrhaman Theyab
- Department of Laboratory and Blood Bank, Security Forces Hospital, Mecca, Makkah, SAU
- Collage of Medicine, Al-Faisal University, Riyadh, SAU
| | - Hamza Assaggaf
- Laboratory Medicine/Public Health, Umm Al-Qura University, Makkah, SAU
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Moradigaravand D, Senok A, Al-Dabal L, Khansaheb HH, Habous M, Alsuwaidi H, Alsheikh-Ali A. Unveiling the dynamics of antimicrobial utilization and resistance in a large hospital network over five years: Insights from health record data analysis. PLOS DIGITAL HEALTH 2023; 2:e0000424. [PMID: 38157341 PMCID: PMC10756551 DOI: 10.1371/journal.pdig.0000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
Antimicrobial Resistance (AMR) presents a pressing public health challenge globally which has been compounded by the COVID-19 pandemic. Elucidation of the impact of the pandemic on AMR evolution using population-level data that integrates clinical, laboratory and prescription data remains lacking. Data was extracted from the centralized electronic platform which captures the health records of 60,551 patients with a confirmed infection across the network of public healthcare facilities in Dubai, United Arab Emirates. For all inpatients and outpatients diagnosed with bacterial infection between 01/01/2017 and 31/05/2022, structured and unstructured Electronic Health Record data, microbiological laboratory data including antibiogram, molecular typing and COVID-19 testing information as well as antibiotic prescribing data were extracted curated and linked. Various analytical methods, including time-series analysis, natural language processing (NLP) and unsupervised clustering algorithms, were employed to investigate the trends of antimicrobial usage and resistance over time, assess the impact of prescription practices on resistance rates, and explore the effects of COVID-19 on antimicrobial usage and resistance. Our findings identified a significant impact of COVID-19 on antimicrobial prescription practices, with short-term and long-lasting over-prescription of these drugs. Resistance to antimicrobials increased the odds ratio of all mortality to an average of 2.18 (95% CI: 1.87-2.49) for the most commonly prescribed antimicrobials. Moreover, the effects of antimicrobial prescription practices on resistance were observed within one week of initiation. Significant trends in antimicrobial resistance, exhibiting fluctuations for various drugs and organisms, with an overall increasing trend in resistance levels, particularly post-COVID-19 were identified. This study provides a population-level insight into the evolution of AMR in the context of COVID-19 pandemic. The findings emphasize the impact of COVID-19 on the AMR crisis, which remained evident even two years after the onset of the pandemic. This underscores the necessity for enhanced antimicrobial stewardship to address the evolution of AMR.
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Affiliation(s)
- Danesh Moradigaravand
- Laboratory for Infectious Disease Epidemiology, KAUST Smart-Health Initiative and Biological and Environmental Science and Engineering (BESE) Division, King Abdullah University of Science and Technology (KAUST) Thuwal, Makkah 23955–6900, Saudi Arabia
- KAUST Computational Bioscience Research Center (CBRC), King Abdullah University of Science and Technology (KAUST), Thuwal, Makkah 23955–6900, Saudi Arabia
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- School of Dentistry, Cardiff University, Cardiff, United Kingdom
| | - Laila Al-Dabal
- Infectious Diseases Unit, Rashid Hospital, Dubai, United Arab Emirates
| | | | - Maya Habous
- Microbiology & Infection Control Unit, Pathology Department, Rashid Hospital, Dubai, United Arab Emirates
| | - Hanan Alsuwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Dubai Academic Health Corporation, Dubai, United Arab Emirates
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Dubai Academic Health Corporation, Dubai, United Arab Emirates
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McSweeney T, Chang MH, Patel P, Nori P. Antimicrobial Stewardship and Pandemic Preparedness: Harnessing Lessons Learned to Advance Our Mission. Infect Dis Clin North Am 2023; 37:669-681. [PMID: 37607841 DOI: 10.1016/j.idc.2023.07.001] [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: 08/24/2023]
Abstract
Antimicrobial stewardship programs (ASPs) demonstrated poise and resilience in assisting with COVID-19 efforts across the globe, harnessing expertise in diagnostic stewardship, therapeutics, protocol development, and use of technology to rapidly expand their scope through strategic collaborations, dissemination of content expertise, and numerous contributions to the body of knowledge on COVID-19. Lessons learned from pandemic response should be used to advance the mission of ASPs and secure a "seat at the table" as health systems continue to expand and adapt to future public health crises.
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Affiliation(s)
| | - Mei H Chang
- Department of Pharmacy, Montefiore Health System, Bronx, NY, USA
| | - Payal Patel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Murray, UT, USA; Infectious Diseases Clinic, Intermountain Medical Center, 5171 Cottonwood Street Suite 350, Murray, UT 84107, USA
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, 3411 Wayne Avenue #4H, Bronx, NY 10467, USA
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Mobarak-Qamsari M, Jenaghi B, Sahebi L, Norouzi-Shadehi M, Salehi MR, Shakoori-Farahani A, Khoshnevis H, Abdollahi A, Feizabadi MM. Evaluation of Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus respiratory tract superinfections among patients with COVID-19 at a tertiary-care hospital in Tehran, Iran. Eur J Med Res 2023; 28:314. [PMID: 37660109 PMCID: PMC10474718 DOI: 10.1186/s40001-023-01303-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/19/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND The emergence of healthcare-associated infections (HAIs) or superinfections in COVID-19 patients has resulted in poor prognosis and increased mortality. METHODS In a cross-sectional study, 101 respiratory samples were collected from ICU-admitted COVID-19 patients. The HAI rate, demographics, and antibiotic resistance were assessed. RESULTS The HAI rate was 83.16% (76.62% bacterial and 6.54% fungal). The prevalence of 3 major HAI-causing organisms included Klebsiella pneumoniae (41.5%), Acinetobacter baumannii (20.8%), and Staphylococcus aureus (4.9%). Mortality and intubation ventilation proportions of 90% (p = 0.027) and 92.2% (p = 0.02) were significant among patients with superinfection, respectively. Multiple logistic regression analysis showed SpO2 pressure (odds ratio 0.842; 95% CI 0.750-0.945; p = 0.004) as a predictive factor in the association between antibiotic usage and mortality. More than 50% of patients received carbapenems. The resistance rates to at least one antibiotic of third-generation cephalosporins, aminoglycosides, quinolones/fluoroquinolones, tetracyclines, and β-lactam inhibitors were 95.2%, 95.2%, 90%, 57.1%, and 100% among A. baumannii isolates and 71.4%, 55%, 69%, 61.9%, and 59.5% among K. pneumoniae isolates, respectively. A proportion of 60% was recorded for methicillin-resistant S. aureus isolates. CONCLUSION As a result, antibiotic treatment should be administered following the microbial resistance profile. Contact isolation and infection control measures should be implemented as needed.
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Affiliation(s)
- Maryam Mobarak-Qamsari
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Jenaghi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leyla Sahebi
- Family Health Research Institute. Maternal, Fetal, and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Norouzi-Shadehi
- Department of Infectious Disease, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Salehi
- Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Shakoori-Farahani
- Department of Medical Genetics, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Khoshnevis
- Imam Khomeini Hospital Complex, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Feizabadi
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Thorax Research Center, Imam Khomeini Hospital Complex., Tehran University of Medical Sciences, Tehran, Iran.
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5
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Flynn CE, Guarner J. Emerging Antimicrobial Resistance. Mod Pathol 2023; 36:100249. [PMID: 37353202 DOI: 10.1016/j.modpat.2023.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023]
Abstract
The burden of emerging antimicrobial resistance (AMR) in the United States is significant and even greater worldwide. Mitigation efforts have decreased the incidence and deaths from antimicrobial-resistant organisms in the United States. Yet more than 2.8 million antimicrobial-resistant infections occur every year and more than 35,000 patients die as a result. Infection prevention and control, data tracking, antimicrobial stewardship, vaccines, therapeutics, diagnostics, and sanitation are all required to decrease AMR threats. In 2019, in the second version of the Centers for Disease Control and Prevention (CDC) report on antibiotic-resistant threats, the agency categorized AMR threats as urgent, serious, concerning, or to be watched. This review will discuss the following aspects of each bacterium in the CDC report: estimated numbers of cases and deaths, identify the better known and impactful mechanisms of resistance, diagnostic testing and its limitations, and current and possible future therapies. This review also presents anatomical pathology case examples that highlight the altered morphology of antibiotic partially treated bacteria in tissues.
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Affiliation(s)
- Cynthia E Flynn
- Department of Pathology, Christiana Care, Wilmington, Delaware.
| | - Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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Buckley MS, Kobic E, Yerondopoulos M, Sharif AS, Benanti GE, Meckel J, Puebla Neira D, Boettcher SR, Khan AA, McNierney DA, MacLaren R. Comparison of Methicillin-Resistant Staphylococcus aureus Nasal Screening Predictive Value in the Intensive Care Unit and General Ward. Ann Pharmacother 2023; 57:1036-1043. [PMID: 36575978 DOI: 10.1177/10600280221145152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The clinical utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening appears promising for antimicrobial stewardship programs. However, a paucity of data remains on the diagnostic performance of culture-based MRSA screen in the intensive care unit (ICU) for pneumonia and bacteremia. OBJECTIVE The objective of this study was to compare the predictive value of culture-based MRSA nasal screening for pneumonia and bacteremia in ICU and general ward patients. METHODS This multicenter, retrospective study was conducted over a 23-month period. Adult patients with MRSA nasal screening ≤48 hours of collecting a respiratory and/or blood culture with concurrent initiation of anti-MRSA therapy were included. The primary endpoint was to compare the negative predictive value (NPV) associated with culture-based MRSA nasal screening between ICU and general ward patients with suspected pneumonia. RESULTS A total of 5106 patients representing the ICU (n = 2515) and general ward (n = 2591) were evaluated. The NPV of the MRSA nares for suspected pneumonia was not significantly different between ICU and general ward patient populations (98.3% and 97.6%, respectively; P = 0.41). The MRSA nares screening tool also had a high NPV for suspected bacteremia in ICU (99.8%) and general ward groups (99.7%) (P = 0.56). The overall positive MRSA nares rates in the ICU and general ward patient populations were 9.1% and 8.2%, respectively (P = 0.283). Moreover, MRSA-positive respiratory and blood cultures among ICU patients were 5.8% and 0.8%, respectively. CONCLUSION AND RELEVANCE Our findings support the routine use of MRSA nasal screening using the culture-based method in ICU patients with pneumonia. Further research on the clinical performance for MRSA bacteremia in the ICU is warranted.
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Affiliation(s)
- Mitchell S Buckley
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Emir Kobic
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | | | - Atefeh S Sharif
- Department of Pharmacy, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Grace E Benanti
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Jordan Meckel
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA
| | - Daniel Puebla Neira
- Department of Pulmonary and Critical Care, The University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | - Abdul A Khan
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Dakota A McNierney
- Department of Medicine, Banner-University Medical Center Phoenix, Phoenix, AZ, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
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Parisini A, Boni S, Vacca EB, Bobbio N, Puente FD, Feasi M, Prinapori R, Lattuada M, Sartini M, Cristina ML, Usiglio D, Pontali E. Impact of the COVID-19 Pandemic on Epidemiology of Antibiotic Resistance in an Intensive Care Unit (ICU): The Experience of a North-West Italian Center. Antibiotics (Basel) 2023; 12:1278. [PMID: 37627698 PMCID: PMC10451647 DOI: 10.3390/antibiotics12081278] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
The SARS-CoV-2 pandemic caused an increase in intensive care unit (ICU) hospitalizations with a rise in morbidity and mortality; nevertheless, there is still little evidence on the impact of the pandemic on antibiotic resistance in ICUs. This is a retrospective, monocentric epidemiological study. The aim of the study was to describe and analyze the impact of the SARS-CoV-2 pandemic on ICU bacterial resistance patterns. All bacteria isolated from all patients admitted to the E.O. Galliera ICU from January 2018 to December 2022 were included. Antibiotic resistance (AR) profiles were evaluated. A total of 1021 microorganisms were identified, of which 221 (12.47%) had a resistance pattern (resistant organisms; ROs). In this time, there were 1679 patients with a total of 12,030 hospitalization days. The majority of microorganisms were Gram-negative (79.66% in 2018, 77.29% in 2019, 61.83% in 2020, 62.56% in 2021, and 60.75% in 2022), but an increase in Gram-positive microorganisms was observed (20.34 to 39.25% between 2018 and 2022). The prevalence of AR was 19.44% in 2018, 11.54% in 2019, 38.04% in 2020, 34.15% in 2021, and 39.29% in 2022 for Gram-positive microorganisms and 19.86% in 2018, 13.56% in 2019, 18.12% in 2020, 12.41% in 2021, and 12.31% in 2012 for Gram-negative microorganisms. The incidence of ROs showed a COVID-19-related increase in 2020-2021, followed by a lowering trend since 2021, and a new increase in 2022. Possible explanations are antibiotic overtreatment and a decrease in containment measures. An interesting finding was the cumulative lowering trend of carbapenem-resistant K. pneumoniae and P. aeruginosa, probably due to different patient features.
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Affiliation(s)
- Andrea Parisini
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Silvia Boni
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Elisabetta Blasi Vacca
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Nicoletta Bobbio
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Filippo Del Puente
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Roberta Prinapori
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
| | - Marco Lattuada
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128 Genoa, Italy;
| | - Marina Sartini
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genoa, Italy; (M.S.); (M.L.C.)
- Operating Unit (S.S.D.U.O.) Hospital Hygiene Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - Maria Luisa Cristina
- Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genoa, Italy; (M.S.); (M.L.C.)
- Operating Unit (S.S.D.U.O.) Hospital Hygiene Unit, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
| | - David Usiglio
- Department of Laboratory and Microbiological Analysis, Galliera Hospital, 16128 Genoa, Italy;
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy; (A.P.); (S.B.); (E.B.V.); (N.B.); (F.D.P.); (M.F.); (R.P.)
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Aslam S, Asrat H, Liang R, Qiu W, Sunny S, Maro A, Abdallah M, Fornek M, Episcopia B, Quale J. Methicillin-resistant Staphylococcus aureus bacteremia during the coronavirus disease 2019 (COVID-19) pandemic: Trends and distinguishing characteristics among patients in a healthcare system in New York City. Infect Control Hosp Epidemiol 2023; 44:1177-1179. [PMID: 36082528 DOI: 10.1017/ice.2022.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
During the pandemic, the rate of healthcare facility-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was 5 times greater in patients admitted with coronavirus disease 2019 (COVID-19). The presence of central lines and mechanical ventilation likely contribute to this increased rate. The number of central-line-associated bacteremia cases may be underestimated in patients with COVID-19.
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Affiliation(s)
- Saif Aslam
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Habtamu Asrat
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Rina Liang
- Department of Medicine, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Wenqi Qiu
- School of Public Health, SUNY Downstate Medical Center, Brooklyn, New York
| | - Subin Sunny
- Department of Pharmacy Services, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Anna Maro
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Marie Abdallah
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - Mary Fornek
- Department of Infection Control and Prevention, NYC Health+Hospitals/Central Office, New York, New York
| | - Briana Episcopia
- Department of Infection Control and Prevention, NYC Health+Hospitals/Kings County, Brooklyn, New York
| | - John Quale
- Division of Infectious Diseases, NYC Health+Hospitals/Kings County, Brooklyn, New York
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Saeheng T, Na-Bangchang K. Simulation of optimal dose regimens of photoactivated curcumin for antimicrobial resistance pneumonia in COVID-19 patients: A modeling approach. Infect Dis Model 2023; 8:S2468-0427(23)00046-5. [PMID: 37361409 PMCID: PMC10239661 DOI: 10.1016/j.idm.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/07/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Background Secondary antimicrobial resistance bacterial (AMR) pneumonia could lead to an increase in mortality in COVID-19 patients, particularly of geriatric patients with underlying diseases. The comedication of current medicines for AMR pneumonia with corticosteroids may lead to suboptimal treatment or toxicities due to drug-drug interactions (DDIs). Objective This study aimed to propose new promising dosage regimens of photoactivated curcumin when co-administered with corticosteroids for the treatment of antimicrobial resistance (AMR) pneumonia in COVID-19 patients. Methods A whole-body physiologically-based pharmacokinetic (PBPK) with the simplified lung compartments model was built and verified following standard model verification (absolute average-folding error or AAFEs). The pharmacokinetic properties of photoactivated were assumed to be similar to curcumin due to minor changes in physiochemical properties of compound by photoactivation. The acceptable AAFEs values were within 2-fold. The verified model was used to simulate new regimens for different formulations of photoactivated curcumin. Results The AAFEs was 1.12-fold. Original formulation (120 mg once-daily dose) or new intramuscular nano-formulation (100 mg with a release rate of 10/h given every 7 days) is suitable for outpatients with MRSA pneumonia to improve patient adherence. New intravenous formulation (2000 mg twice-daily doses) is for hospitalized patients with both MRSA and VRSA pneumonia. Conclusion The PBPK models, in conjunction with MIC and applied physiological changes in COVID-19 patients, is a potential tool to predict optimal dosage regimens of photoactivated curcumin for the treatment of co-infected AMR pneumonia in COVID-19 patients. Each formulation is appropriate for different patient conditions and pathogens.
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Affiliation(s)
- Teerachat Saeheng
- Centre of Excellence in Pharmacology and Molecular Biology of Malaria and Cholangiocarcinoma, Chulabhorn International College, 99 Moo 18, Phaholyothin Road, Thammasat University (Rangsit Campus), Klongneung, Klongluang District, Pathumthani, 12121, Thailand
| | - Kesara Na-Bangchang
- Centre of Excellence in Pharmacology and Molecular Biology of Malaria and Cholangiocarcinoma, Chulabhorn International College, 99 Moo 18, Phaholyothin Road, Thammasat University (Rangsit Campus), Klongneung, Klongluang District, Pathumthani, 12121, Thailand
- Drug Discovery and Development Centre, Office of Advanced Science and Technology, 99 Moo 18, Phaholyothin Road, Thammasat University (Rangsit Campus), Klongneung, Klongluang, Pathumthani, 12121, Thailand
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10
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Hawsawi NM, Hamad AM, Rashid SN, Alshehri F, Sharaf M, Zakai SA, Al Yousef SA, Ali AM, Abou-Elnour A, Alkhudhayri A, Elrefaei NG, Elkelish A. Biogenic silver nanoparticles eradicate of Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) isolated from the sputum of COVID-19 patients. Front Microbiol 2023; 14:1142646. [PMID: 37143540 PMCID: PMC10153441 DOI: 10.3389/fmicb.2023.1142646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
In recent investigations, secondary bacterial infections were found to be strongly related to mortality in COVID-19 patients. In addition, Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA) bacteria played an important role in the series of bacterial infections that accompany infection in COVID-19. The objective of the present study was to investigate the ability of biosynthesized silver nanoparticles from strawberries (Fragaria ananassa L.) leaf extract without a chemical catalyst to inhibit Gram-negative P. aeruginosa and Gram-positive Staph aureus isolated from COVID-19 patient’s sputum. A wide range of measurements was performed on the synthesized AgNPs, including UV–vis, SEM, TEM, EDX, DLS, ζ -potential, XRD, and FTIR. UV-Visible spectral showed the absorbance at the wavelength 398 nm with an increase in the color intensity of the mixture after 8 h passed at the time of preparation confirming the high stability of the FA-AgNPs in the dark at room temperature. SEM and TEM measurements confirmed AgNPs with size ranges of ∼40-∼50 nm, whereas the DLS study confirmed their average hydrodynamic size as ∼53 nm. Furthermore, Ag NPs. EDX analysis showed the presence of the following elements: oxygen (40.46%), and silver (59.54%). Biosynthesized FA-AgNPs (ζ = −17.5 ± 3.1 mV) showed concentration-dependent antimicrobial activity for 48 h in both pathogenic strains. MTT tests showed concentration-dependent and line-specific effects of FA-AgNPs on cancer MCF-7 and normal liver WRL-68 cell cultures. According to the results, synthetic FA-AgNPs obtained through an environmentally friendly biological process are inexpensive and may inhibit the growth of bacteria isolated from COVID-19 patients.
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11
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Bongiovanni M, Barda B. Pseudomonas aeruginosa Bloodstream Infections in SARS-CoV-2 Infected Patients: A Systematic Review. J Clin Med 2023; 12:jcm12062252. [PMID: 36983256 PMCID: PMC10056033 DOI: 10.3390/jcm12062252] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Bacterial co-infections increase the severity of respiratory viral infections and are frequent causes of mortality in COVID-19 infected subjects. During the COVID-19 period, especially at the beginning of the pandemic, an inappropriate use of broad-spectrum antibiotic treatments has been frequently described, mainly due to prolonged hospitalization, especially in intensive care unit departments, and the use of immune-suppressive treatments as steroids. This misuse has finally led to the occurrence of infections by multi-drug resistant (MDR) bacteria in hospitalized COVID-19 patients. Although different reports assessed the prevalence of Gram-negative infections in COVID-19 infected patients, scarce data are currently available on bloodstream infections caused by Pseudomonas aeruginosa in hospitalized COVID-19 patients. The aim of our systematic review is to describe data on this specific population and to discuss the possible implications that these co-infections could have in the management of COVID-19 pandemics in the future. We systematically analysed the current literature to find all the relevant articles that describe the occurrence of P. aeruginosa bloodstream infections in COVID-19 patients. We found 40 papers that described in detail P. aeruginosa HAIs-BSI in COVID-19 patients, including 756,067 patients overall. The occurrence of severe infections due to MDR bacteria had a significant impact in the management of hospitalized patients with COVID-19 infections, leading to a prolonged time of hospitalization and to a consequent increase in mortality. In the near future, the increased burden of MDR bacteria due to the COVID-19 pandemic might partially be reduced by maintaining the preventive measures of infection control implemented during the acute phase of the COVID-19 pandemic. Finally, we discuss how the COVID-19 pandemic changed the role of antimicrobial stewardship in healthcare settings, according to the isolation of MDR bacteria and how to restore on a large scale the optimization of antibiotic strategies in COVID-19 patients.
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12
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Liu C, Holubar M. Should a MRSA Nasal Swab Guide Empiric Antibiotic Treatment? NEJM EVIDENCE 2022; 1:EVIDccon2200124. [PMID: 38319836 DOI: 10.1056/evidccon2200124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
MRSA Nasal Swab and Empiric Antibiotic TreatmentMRSA nasal screening has emerged as a potential antimicrobial stewardship tool to guide empiric use of anti-MRSA therapy. The authors address diagnostic considerations when performing MRSA nasal screening and clinical situations in which its results may be used to guide empiric antibiotic therapy in hospitalized patients.
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Affiliation(s)
- Catherine Liu
- Vaccine and Infectious Disease and Clinical Research Divisions, Fred Hutchinson Cancer Center, Seattle
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
| | - Marisa Holubar
- Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, Stanford, CA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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13
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SHEA statement on antibiotic stewardship in hospitals during public health emergencies. Infect Control Hosp Epidemiol 2022; 43:1541-1552. [PMID: 36102000 PMCID: PMC9672827 DOI: 10.1017/ice.2022.194] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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14
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Lung BE, Taka TM, Donnelly M, McLellan M, Callan K, Issagholian L, Lai W, So D, McMaster W, Yang S. Prior Diagnosis of COVID Has No Increased Complications in Total Joint Arthroplasty. Cureus 2022; 14:e27974. [PMID: 36120273 PMCID: PMC9467498 DOI: 10.7759/cureus.27974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Although a substantial portion of the United States population has been infected with and recovered from Coronavirus Disease-19 (COVID-19), many patients may have persistent symptoms and complications from disease-driven respiratory disease, arrhythmias, and venous thromboembolism (VTE). With institutions resuming elective total joint arthroplasties (TJA), it is unclear whether a prior resolved diagnosis of COVID has any implications on postoperative outcomes. Methods All elective TJA performed in 2021 at our institution were retrospectively reviewed and a history of prior COVID+ result recorded. Baseline demographics, days from prior COVID+ result to surgery date, preoperative methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, and laboratory markers were obtained to determine baseline characteristics. Postoperative estimated blood loss (EBL), length of stay (LOS), rate of revision surgery, and discharge destination were compared between groups. Perioperative and postoperative rates of VTE, urinary tract infection (UTI), pneumonia, postoperative oxygen supplementation, cardiac arrhythmia, renal disease, sepsis, and periprosthetic joint infections within six months of surgery were recorded. Results Of the 155 elective TJA performed in 2021, 24 patients had a prior COVID+ diagnosis with a mean of 253 days from positive result to surgery date. There were no significant differences in baseline demographics, comorbidities, and preoperative lab markers between groups. Surgeries on patients with a prior COVID+ had a significantly higher EBL (260 vs 175cc), but postoperative outcomes of VTE, UTI, pneumonia, oxygen supplementation requirement, nares MRSA+, cardiac disease, and infection rates between groups were similar. Bivariate logistic regression revealed increased days from COVID+ diagnosis (>6 months) to surgery date were associated with a shorter LOS. Conclusion Although a prior COVID+ diagnosis had increased intraoperative blood loss, there were no significant differences in respiratory, infectious, cardiac, and thromboembolic complications up to six months after elective TJA. This study suggests that asymptomatic C+ patients receiving elective TJA do not require more aggressive prophylactic anticoagulation or antibiotic regimens to prevent VTE or perioperative infections. As institutions around the nation resume pre-COVID rates of arthroplasty surgeries, a prior diagnosis of COVID appears to have no effects on postoperative complications.
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15
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Antimicrobial Resistance Patterns of Bacterial and Fungal Isolates in COVID-19. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-121580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The pattern of bacterial infection in coronavirus disease 2019 (COVID-19) patients differ worldwide. Objectives: This study aimed to determine the patterns of bacterial infections and the antibiotic resistance profile by VITEK 2 (bioMérieux, France) in the culture of blood samples from hospitalized patients with COVID-19. Methods: This retrospective descriptive cross-sectional was conducted on a total of 25 patients with critical COVID-19 admitted to Imam Reza Hospital in Mashhad, Iran, during the first three COVID-19 peaks (2019 - 2020). Results: Among Gram-positive bacteria, two strains isolated from Staphylococcus aureus were methicillin-resistant S. aureus at a concentration of > 2 μg/mL. Enterococcus was vancomycin-resistant Enterococcus at a concentration of higher than 4 μg/mL (the minimum inhibitory concentration [MIC] ≥ 32). Among Gram-negative bacteria, three strains of Acinetobacter baumannii complex were extensively drug-resistant. Conclusions: There is evidence of the remarkable increase of various antibiotics’ MIC during the COVID-19 pandemic, which highlights the impact of the use of steroids on the risk of developing antimicrobial resistance during the COVID-19 pandemic.
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16
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Abstract
PURPOSE OF REVIEW Some patients with coronavirus disease 2019 (COVID-19) may develop pulmonary bacterial coinfection or superinfection, that could unfavorably impact their prognosis. RECENT FINDINGS The exact burden of methicillin-resistant Staphylococcus aureus (MRSA) lung infection in peculiar populations such as patients with COVID-19 remains somewhat elusive, possibly because of wide heterogeneity in methods and endpoints across studies. SUMMARY There was important heterogeneity in the retrieved literature on the epidemiology of MRSA lung infection in patients with COVID-19, both when considering all other bacteria as the denominator (relative prevalence ranging from 2% to 29%) and when considering only S. aureus as the denominator (relative prevalence ranging from 11% to 65%). Overall, MRSA is among the most frequent causative agents of pulmonary infection in patients with COVID-19. Improving our ability to rapidly reach etiological diagnosis of bacterial lung infection in COVID-19 patients remains fundamental if we are to improve the rates of appropriate antibiotic therapy in patients with COVID-19 and concomitant/superimposed MRSA infection, at the same time avoiding antibiotic overuse in line with antimicrobial stewardship principles.
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17
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Pickens CI, Wunderink RG. Methicillin-Resistant Staphylococcus aureus Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia. Semin Respir Crit Care Med 2022; 43:304-309. [PMID: 35170002 PMCID: PMC10623688 DOI: 10.1055/s-0041-1740583] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). MRSA pneumonia is associated with significant morbidity and mortality. Several virulence factors allow S. aureus to become an effective pathogen. The polysaccharide intracellular adhesin allows for the production of biofilms, some strains can produce capsular polysaccharides that protect against phagocytosis, microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) allow for colonization of epithelial surfaces, and S. aureus secretes several exotoxins that aid in tissue destruction. The α-hemolysin exotoxin secreted by S. aureus is one of the most important virulence factors for the bacteria. The diagnosis of MRSA pneumonia can be challenging; the infection may present as a mild respiratory infection or severe respiratory failure and septic shock. Many individuals are colonized with MRSA and thus a positive nasopharyngeal swab does not confirm infection in the lower respiratory tract. The management of MRSA pneumonia has evolved. Historically, vancomycin has been the primary antibiotic used to treat MRSA pneumonia. Over the past decade, prospective studies have shown that linezolid leads to higher rates of clinical cure. Monoclonal antibodies are being studied as potential therapeutic options. MRSA is an important cause of HAP/VAP; novel diagnostics may facilitate rapid diagnosis of this infection and the available literature should be used to make informed decisions on management.
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Affiliation(s)
- Chiagozie I. Pickens
- Division of Critical Care, Department of Medicine, Pulmonary, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G. Wunderink
- Division of Critical Care, Department of Medicine, Pulmonary, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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18
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Mandadi S, Pulluru H, Annie F. Comparative outcomes of combined corticosteroid and remdesivir therapy with corticosteroid monotherapy in ventilated COVID-19 patients. PLoS One 2022; 17:e0264301. [PMID: 35196344 PMCID: PMC8865672 DOI: 10.1371/journal.pone.0264301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/09/2022] [Indexed: 12/15/2022] Open
Abstract
Remdesivir (RDV) reduces time to clinical improvement in hospitalized COVID -19 patients requiring supplemental oxygen. Dexamethasone improves survival in those requiring oxygen support. Data is lacking on the efficacy of combination therapy in patients on mechanical ventilation. We analyzed for comparative outcomes between Corticosteroid (CS) therapy with combined Corticosteroid and Remdesivir (CS-RDV) therapy. We conducted an observational cohort study of patients aged 18 to 90 with COVID-19 requiring ventilatory support using TriNetX (COVID-19 Research Network) between January 20, 2020, and February 9, 2021. We compared patients who received at least 48 hours of CS-RDV combination therapy to CS monotherapy. The primary outcome was 28-day all-cause mortality rates in propensity-matched (PSM) cohorts. Secondary outcomes were Length of Stay (LOS), Secondary Bacterial Infections (SBI), and MRSA (Methicillin-Resistant Staphylococcus aureus), and Pseudomonas infections. We used univariate and multivariate Cox proportional hazards models and stratified log-rank tests. Of 388 patients included, 91 (23.5%) received CS-RDV therapy, and 297 (76.5%) received CS monotherapy. After propensity score matching, with 74 patients in each cohort, all-cause mortality was 36.4% and 29.7% in the CS-RDV and CS therapy, respectively (P = 0.38). We used a Kaplan-Meier with a log-rank test on follow up period (P = 0.23), and a Hazards Ratio model (P = 0.26). SBI incidence was higher in the CS group (13.5% vs. 35.1%, P = 0.02) with a similar LOS (13.4 days vs. 13.4 days, P = 1.00) and similar incidence of MRSA/Pseudomonas infections (13.5% vs. 13.5%, P = 1.00) in both the groups. Therefore, CS-RDV therapy is non-inferior to CS therapy in reducing 28-day all-cause in-hospital mortality but associated with a significant decrease in the incidence of SBI in critically ill COVID-19 patients.
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Affiliation(s)
- Subhadra Mandadi
- Department of Infectious Diseases, Charleston Area Medical Center, Charleston, West Virginia, United States of America
- * E-mail:
| | - Harish Pulluru
- Department of Hospital Medicine, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Frank Annie
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia, United States of America
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19
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McCraw C, Forbush S, Trivedi K. Community-Acquired, Post-COVID-19, Methicillin-Resistant Staphylococcus aureus Pneumonia and Empyema. Cureus 2022; 14:e22121. [PMID: 35308686 PMCID: PMC8918236 DOI: 10.7759/cureus.22121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has presented unprecedented challenges to the healthcare system globally, with opportunistic and secondary infections being one of the biggest challenges. Most secondary infections occur as nosocomial infections due to exposure to multidrug-resistant organisms in healthcare facilities. Secondary bacterial pneumonia complicates the care of hospitalized COVID-19 pneumonia patients. We present the case of a 77-year-old male who was diagnosed with COVID-19 pneumonia about four weeks before the current presentation to the hospital and was treated symptomatically in the community setting. During workup, he was diagnosed with multifocal pneumonia and right-sided empyema caused by methicillin-resistant Staphylococcus aureus (MRSA). He underwent chest tube thoracostomy followed by intrapleural fibrinolysis along with targeted antibiotic therapy. He needed video-assisted thoracoscopy with decortication due to inadequate improvement with intrapleural fibrinolysis. This case is a rare presentation of a community-acquired MRSA lung infection that occurred after recovery from COVID-19 pneumonia. This case emphasizes the importance of monitoring for secondary infections, as well as highlights the extent of secondary infections in COVID-19.
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20
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O'Toole RF. The interface between COVID-19 and bacterial healthcare-associated infections. Clin Microbiol Infect 2021; 27:1772-1776. [PMID: 34111586 PMCID: PMC8182977 DOI: 10.1016/j.cmi.2021.06.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND A wide range of bacterial infections occur in coronavirus disease 2019 (COVID-19) patients, particularly in those with severe coronaviral disease. Some of these are community-acquired co-infections. OBJECTIVE To review recent data that indicate the occurrence of hospital-onset bacterial infections, including with antibiotic-resistant isolates, in COVID-19 patients. SOURCES Using PubMed, the literature was searched using terms including: 'COVID-19'; 'SARS-CoV-2'; 'bacterial infection'; 'healthcare-associated infection'; 'antibiotic resistance'; 'antimicrobial resistance'; 'multi-drug resistance'; 'Streptococcus'; 'Staphylococcus'; 'Pseudomonas'; 'Escherichia'; 'Klebsiella'; 'Enterococcus'; 'Acinetobacter'; 'Haemophilus'; 'MRSA'; 'VRE'; 'ESBL'; 'NDM-CRE'; 'CR-Ab'; 'VRSA'; 'MDR'. CONTENT There is a growing number of reports of bacterial infections acquired by patients with severe COVID-19 after hospital admission. Antibiotic-resistant pathogens found to cause healthcare-associated infections (HAIs) in COVID-19 patients include methicillin-resistant Staphylococcus aureus, New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase Klebsiella pneumoniae and vancomycin-resistant enterococci. COVID-19 has impacted bacterial HAIs in a number of ways with an increase in the incidence of New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales and carbapenem-resistant A. baumannii reported at some hospital sites compared with before the pandemic. Recommended guidelines for antimicrobial stewardship in COVID-19 patient treatment are discussed regarding minimization of empiric broad-spectrum antibiotic use. Other studies have reported a decrease in methicillin-resistant S. aureus and vancomycin-resistant enterococci cases, which has been attributed to enhanced infection prevention and control practices introduced to minimize intra-hospital spread of COVID-19. IMPLICATIONS Poorer outcomes have been observed in hospitalized COVID-19 patients with an antibiotic-resistant infection. Although heightened IPC measures have been accompanied by a reduction in some HAIs at specific sites, in other situations, COVID-19 has been associated with an increase in bacterial HAI incidence. Further research is needed to define the cost-benefit relationship of maintaining COVID-19-related infection prevention and control protocols beyond the pandemic to reduce the burden of HAIs. In addition, the longer-term impact of high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic requires evaluation.
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Affiliation(s)
- Ronan F O'Toole
- Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.
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21
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Segala FV, Bavaro DF, Di Gennaro F, Salvati F, Marotta C, Saracino A, Murri R, Fantoni M. Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review. Viruses 2021; 13:2110. [PMID: 34834917 PMCID: PMC8624326 DOI: 10.3390/v13112110] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 01/08/2023] Open
Abstract
Antimicrobial resistance is an urgent threat to public health and global development; in this scenario, the SARS-CoV2 pandemic has caused a major disruption of healthcare systems and practices. A narrative review was conducted on articles focusing on the impact of COVID-19 on multidrug-resistant gram-negative, gram-positive bacteria, and fungi. We found that, worldwide, multiple studies reported an unexpected high incidence of infections due to methicillin-resistant S. aureus, carbapenem-resistant A. baumannii, carbapenem-resistant Enterobacteriaceae, and C. auris among COVID-19 patients admitted to the intensive care unit. In this setting, inappropriate antimicrobial exposure, environmental contamination, and discontinuation of infection control measures may have driven selection and diffusion of drug-resistant pathogens.
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Affiliation(s)
- Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of Bari, 70121 Bari, Italy; (D.F.B.); (F.D.G.); (A.S.)
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University of Bari, 70121 Bari, Italy; (D.F.B.); (F.D.G.); (A.S.)
| | - Federica Salvati
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
| | - Claudia Marotta
- General Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy;
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari, 70121 Bari, Italy; (D.F.B.); (F.D.G.); (A.S.)
| | - Rita Murri
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Massimo Fantoni
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.S.); (R.M.); (M.F.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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22
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Coutinho TDNP, Barroso FDD, da Silva CR, da Silva AR, Cabral VPDF, Sá LGDAV, Cândido TM, da Silva LJ, Ferreira TL, da Silva WMB, Silva J, Marinho ES, Cavalcanti BC, Moraes MO, Nobre Júnior H, Andrade Neto JBD. EFFECTS OF KETAMINE IN METHICILLIN RESISTANT S. aureus AND IN SILICO INTERACTION WITH SORTASE A. Can J Microbiol 2021; 67:885-893. [PMID: 34314621 DOI: 10.1139/cjm-2021-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the main human pathogens and is responsible for many diseases ranging from skin infections to more invasive infections. These infections are dangerous and expensive to treat because these strains are resistant to a large number of conventional antibiotics. Having said that, Antibacterial effect of ketamine against MRSA strains, its mechanism of action and in silico interaction with sortase A was evaluated. The antibacterial effect of ketamine was assessed by the broth microdilution method. Subsequently, the mechanism of action was assessed using flow cytometry and molecular docking assays with sortase A. Our results showed that Ketamine has a significant antibacterial activity against MRSA strains in the range of 2.49 to 3.73 mM. Their mechanism of action involves alterations in the membrane integrity and DNA damage, reducing cell viability that provoke death by apoptosis. In addition, Ketamine compound had affinity for S. aureus sortase A. These results indicate that this compound can be an alternative to develop new strategies to combat of infections caused by MRSA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jacilene Silva
- State University of Ceara, 67843, Fortaleza, CE, Brazil;
| | | | | | | | - Hélio Nobre Júnior
- Federal University of Ceará, Department of Clinical and Toxicological Analysis, Rua Capitão Francisco Pedro, 1210 - Rodolfo Teófilo, Fortaleza, Brazil, 60430-370;
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23
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Westblade LF, Simon MS, Satlin MJ. Bacterial coinfections in coronavirus disease 2019. Trends Microbiol 2021; 29:930-941. [PMID: 33934980 PMCID: PMC8026275 DOI: 10.1016/j.tim.2021.03.018] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
Bacterial coinfections increase the severity of respiratory viral infections and were frequent causes of mortality in influenza pandemics but have not been well characterized in patients with coronavirus disease 2019 (COVID-19). The aim of this review was to identify the frequency and microbial etiologies of bacterial coinfections that are present upon admission to the hospital and that occur during hospitalization for COVID-19. We found that bacterial coinfections were present in <4% of patients upon admission and the yield of routine diagnostic tests for pneumonia was low. When bacterial coinfections did occur, Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae were the most common pathogens and atypical bacteria were rare. Although uncommon upon admission, bacterial infections frequently occurred in patients with prolonged hospitalization, and Pseudomonas aeruginosa, Klebsiella spp., and S. aureus were common pathogens. Antibacterial therapy and diagnostic testing for bacterial infections are unnecessary upon admission in most patients hospitalized with COVID-19, but clinicians should be vigilant for nosocomial bacterial infections.
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Affiliation(s)
- Lars F Westblade
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Matthew S Simon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Satlin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA; Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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24
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Malishev R, Salinas N, Gibson J, Eden AB, Mieres-Perez J, Ruiz-Blanco YB, Malka O, Kolusheva S, Klärner FG, Schrader T, Sanchez-Garcia E, Wang C, Landau M, Bitan G, Jelinek R. Inhibition of Staphylococcus aureus biofilm-forming functional amyloid by molecular tweezers. Cell Chem Biol 2021; 28:1310-1320.e5. [PMID: 33852903 DOI: 10.1016/j.chembiol.2021.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/19/2021] [Accepted: 03/19/2021] [Indexed: 02/07/2023]
Abstract
Biofilms are rigid and largely impenetrable three-dimensional matrices constituting virulence determinants of various pathogenic bacteria. Here, we demonstrate that molecular tweezers, unique supramolecular artificial receptors, modulate biofilm formation of Staphylococcus aureus. In particular, the tweezers affect the structural and assembly properties of phenol-soluble modulin α1 (PSMα1), a biofilm-scaffolding functional amyloid peptide secreted by S. aureus. The data reveal that CLR01, a diphosphate tweezer, exhibits significant S. aureus biofilm inhibition and disrupts PSMα1 self-assembly and fibrillation, likely through inclusion of lysine side chains of the peptide. In comparison, different peptide binding occurs in the case of CLR05, a tweezer containing methylenecarboxylate units, which exhibits lower affinity for the lysine residues yet disrupts S. aureus biofilm more strongly than CLR01. Our study points to a possible role for molecular tweezers as potent biofilm inhibitors and antibacterial agents, particularly against untreatable biofilm-forming and PSM-producing bacteria, such as methicillin-resistant S. aureus.
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Affiliation(s)
- Ravit Malishev
- Department of Chemistry, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Nir Salinas
- Department of Biology, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - James Gibson
- Center for Biotechnology and Interdisciplinary Studies, Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Angela Bailey Eden
- Center for Biotechnology and Interdisciplinary Studies, Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Joel Mieres-Perez
- Department of Computational Biochemistry, University of Duisburg-Essen, Universitätsstrasse 2, 45141 Essen, Germany
| | - Yasser B Ruiz-Blanco
- Department of Computational Biochemistry, University of Duisburg-Essen, Universitätsstrasse 2, 45141 Essen, Germany
| | - Orit Malka
- Department of Chemistry, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Sofiya Kolusheva
- Ilse Katz Institute for Nanotechnology, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | | | - Thomas Schrader
- Faculty of Chemistry, University of Duisburg-Essen, Essen, Germany
| | - Elsa Sanchez-Garcia
- Department of Computational Biochemistry, University of Duisburg-Essen, Universitätsstrasse 2, 45141 Essen, Germany
| | - Chunyu Wang
- Center for Biotechnology and Interdisciplinary Studies, Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Meytal Landau
- Department of Biology, Technion-Israel Institute of Technology, Haifa 3200003, Israel; European Molecular Biology Laboratory (EMBL), 22607 Hamburg, Germany
| | - Gal Bitan
- Department of Neurology, David Geffen School of Medicine, Brain Research Institute, and Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Raz Jelinek
- Department of Chemistry, Ben Gurion University of the Negev, Beer Sheva 84105, Israel; Ilse Katz Institute for Nanotechnology, Ben Gurion University of the Negev, Beer Sheva 84105, Israel.
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25
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Wee LEI, Conceicao EP, Tan JY, Magesparan KD, Amin IBM, Ismail BBS, Toh HX, Jin P, Zhang J, Wee EGL, Ong SJM, Lee GLX, Wang AEM, How MKB, Tan KY, Lee LC, Phoon PC, Yang Y, Aung MK, Sim XYJ, Venkatachalam I, Ling ML. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. Am J Infect Control 2021; 49:469-477. [PMID: 33157180 PMCID: PMC7610096 DOI: 10.1016/j.ajic.2020.10.019] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent health care-associated transmission of COVID-19. We evaluated the impact of a multimodal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs). METHODOLOGY From February-August 2020, a multimodal IPC strategy was implemented across a large health care campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and postpandemic: health care-associated respiratory-viral-infection (HA-RVI), methicillin-resistant Staphylococcus aureus, and CP-CRE acquisition rates, health care-facility-associated C difficile infections and device-associated HAIs. RESULTS Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio = 0.08; 95% confidence interval [CI] = 0.05-0.13, P< .05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio = 0.54, 95% CI = 0.46-0.64, P< .05), together with central-line-associated-bloodstream infection rates (incidence-rate-ratio = 0.24, 95% CI = 0.07-0.57, P< .05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable. CONCLUSIONS Multimodal IPC strategies can be implemented at scale to successfully mitigate health care-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions.
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Affiliation(s)
- Liang En Ian Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jing Yuan Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Kamini Devi Magesparan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | | | | | - Hui Xian Toh
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Pinhong Jin
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jing Zhang
- Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
| | - Elaine Geok Ling Wee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Sheena Jin Min Ong
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Gillian Li Xin Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Amanda En-Min Wang
- Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
| | - Molly Kue Bien How
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Lai Chee Lee
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Poh Choo Phoon
- Department of Nursing Speciality Care Unit, National Heart Centre, Singapore
| | - Yong Yang
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
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26
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Knight GM, Glover RE, McQuaid CF, Olaru ID, Gallandat K, Leclerc QJ, Fuller NM, Willcocks SJ, Hasan R, van Kleef E, Chandler CIR. Antimicrobial resistance and COVID-19: Intersections and implications. eLife 2021; 10:e64139. [PMID: 33588991 PMCID: PMC7886324 DOI: 10.7554/elife.64139] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break down. Over 6 months into the COVID-19 pandemic, the dynamics of AMR remain uncertain. We call for the AMR community to keep a global perspective while designing finely tuned surveillance and research to continue to improve our preparedness and response to these intersecting public health challenges.
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Affiliation(s)
- Gwenan M Knight
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
- TB Centre, LSHTMLondonUnited Kingdom
| | - Rebecca E Glover
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, LSHTMLondonUnited Kingdom
| | - C Finn McQuaid
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
- TB Centre, LSHTMLondonUnited Kingdom
| | - Ioana D Olaru
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
- Biomedical Research and Training InstituteZambezi RiverZimbabwe
| | - Karin Gallandat
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Quentin J Leclerc
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
| | - Naomi M Fuller
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Centre for Mathematical Modelling of Infectious Diseases (CMMID), LSHTMLondonUnited Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, LSHTMLondonUnited Kingdom
| | - Sam J Willcocks
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Rumina Hasan
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Pathology and Laboratory Medicine, Aga Khan UniversityKarachiPakistan
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, LSHTMLondonUnited Kingdom
| | - Esther van Kleef
- Department of Public Heath, Institute of Tropical MedicineAntwerpBelgium
| | - Clare IR Chandler
- AMR Centre, London School of Hygiene and Tropical Medicine (LSHTM)LondonUnited Kingdom
- Department of Global Health and Development, Faculty of Public Health and Policy, LSHTMLondonUnited Kingdom
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27
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Adeiza SS, Shuaibu AB, Shuaibu GM. Random effects meta-analysis of COVID-19/S. aureus partnership in co-infection. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc29. [PMID: 33299742 PMCID: PMC7709160 DOI: 10.3205/dgkh000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim: To assess the hypothesis that coinfection with SARS-CoV-2 and S. aureus exacerbates morbidity and mortality among patients, the study aims to report the pooled burden of S. aureus co-infections in patients hospitalized with COVID-19. Methods: We searched electronic databases and the bibliographies of pertinent papers for articles. We considered studies in which the core result was the number of patients with bacterial (S. aureus) co-infection. We performed random effects meta-analysis (REM) because the studies included were sampled from a universe of different populations and high heterogeneity was anticipated. Using the Cochran's Q statistic, the observed dispersion (heterogeneity) among effect sizes was assessed. The percentage of total variability in the estimates of the effect size was calculated with the I2 index. To check for publication bias, the Egger weighted regression, Begg rank correlation and meta-funnel plot were used. We conducted meta-regression analysis to evaluate the variability between our outcomes and the covariates using computational options such as "methods of moments" and then "maximum likelihood" ratio. Results: We included 18 studies and retrieved data for 63,370 patients hospitalized with influenza-like illness, of which about 14,369 (22.67%) tested positive for COVID-19 by rRT-PCR. Of this number, 8,249 (57.4%) patient samples were analyzed. Bacterial, fungal and viral agents were detected in 3,038 (36.8%); S. aureus in 1,192 (39.2%). Five studies reported MRSA co-infection. Study quality ranged from 6 to 9 (median 7.1) on a JBI scale. From the meta-analysis, 33.1% patients were found to be coinfected (95%, CI 18.0 to 52.6%, Q=3473: df=17, I2=99·48%, p=0.00). The rate of S. aureus /COVID-19 co-infection was 25.6% (95% CI: 15.6 to 39.0, Q=783.4, df=17, I2=97.702%, p=0.003).The proportion of COVID-19/S. aureus co-infected patients with MRSA was 53.9% (95% CI, 24.5 to 80.9, n=66, 5 studies, Q=29.32, df=4, I2=86.369%, p=0.000). With the multivariate meta-regression model, study type (p=0.029), quality (p=0.000) and country (p=0.000) were significantly associated with heterogeneity. Conclusions: The pooled rates of S. aureus among COVID-19 patients documented in this study support the concern of clinicians about the presence of S. aureus in co-infections. Improved antibiotic stewardship can be accomplished through rapid diagnosis by longitudinal sampling of patients.
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Affiliation(s)
- Suleiman Shuaibu Adeiza
- Department of Pharmaceutical Microbiology, Faculty of Pharmaceutical sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Abdulmalik Bello Shuaibu
- Department of Veterinary Microbiology, Faculty of Veterinary medicine, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Gazali Mohammed Shuaibu
- Department of Microbiology, Faculty of sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
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