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van Vuren RMG, Janssen YF, Hogenbirk RNM, de Graaff MR, van den Hoek R, Kruijff S, Heineman DJ, van der Plas WY, Wouters MWJM. The Impact of the COVID-19 Pandemic on Time to Treatment in Surgical Oncology: A National Registry Study in The Netherlands. Cancers (Basel) 2024; 16:1738. [PMID: 38730690 PMCID: PMC11083561 DOI: 10.3390/cancers16091738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
To avoid delay in oncological treatment, a 6-weeks norm for time to treatment has been agreed on in The Netherlands. However, the impact of the COVID-19 pandemic on health systems resulted in reduced capacity for regular surgical care. In this study, we investigated the impact of the COVID-19 pandemic on time to treatment in surgical oncology in The Netherlands. METHODS A population-based analysis of data derived from five surgical audits, including patients who underwent surgery for lung cancer, colorectal cancer, upper gastro-intestinal, and hepato-pancreato-biliary (HPB) malignancies, was performed. The COVID-19 cohort of 2020 was compared to the historic cohorts of 2018 and 2019. Primary endpoints were time to treatment initiation and the proportion of patients whose treatment started within 6 weeks. The secondary objective was to evaluate the differences in characteristics and tumour stage distribution between patients treated before and during the COVID-19 pandemic. RESULTS A total of 14,567 surgical cancer patients were included in this study, of these 3292 treatments were started during the COVID-19 pandemic. The median time to treatment decreased during the pandemic (26 vs. 27 days, p < 0.001) and the proportion of patients whose treatment started within 6 weeks increased (76% vs. 73%, p < 0.001). In a multivariate logistic regression analysis, adjusting for patient characteristics, no significant difference in post-operative outcomes between patients who started treatment before or after 6 weeks was found. Overall, the number of procedures performed per week decreased by 8.1% during the pandemic. This reduction was most profound for patients with stage I lung carcinoma and colorectal carcinoma. There were fewer patients with pulmonary comorbidities in the pandemic cohort (11% vs. 13%, p = 0.003). CONCLUSIONS Despite pressure on the capacity of the healthcare system during the COVID-19 pandemic, a larger proportion of surgical oncological patients started treatment within six weeks, possibly due to prioritisation of cancer care and reductions in elective procedures. However, during the pandemic, a decrease in the number of surgical oncological procedures performed in The Netherlands was observed, especially for patients with stage I disease.
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Affiliation(s)
- Roos M. G. van Vuren
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Yester F. Janssen
- Department of Neurosurgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands;
- TRACER Europe B.V., Aarhusweg 2-1, 9723 JJ Groningen, The Netherlands
| | - Rianne N. M. Hogenbirk
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Michelle R. de Graaff
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
- Dutch Institute for Clinical Auditing, Scientific Bureau, 2333 AA Leiden, The Netherlands
| | - Rinske van den Hoek
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
| | - Schelto Kruijff
- Department of Surgery, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands; (R.M.G.v.V.); (R.N.M.H.); (M.R.d.G.); (R.v.d.H.); (S.K.)
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, 9713 GZ Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - David J. Heineman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.J.H.); (W.Y.v.d.P.)
| | - Willemijn Y. van der Plas
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.J.H.); (W.Y.v.d.P.)
| | - Michel W. J. M. Wouters
- Dutch Institute for Clinical Auditing, Scientific Bureau, 2333 AA Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, 1066 CX Amsterdam, The Netherlands
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2
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Brinkman S, de Keizer NF, de Lange DW, Dongelmans DA, Termorshuizen F, van Bussel BCT. Strain on Scarce Intensive Care Beds Drives Reduced Patient Volumes, Patient Selection, and Worse Outcome: A National Cohort Study. Crit Care Med 2024; 52:574-585. [PMID: 38095502 PMCID: PMC10930373 DOI: 10.1097/ccm.0000000000006156] [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: 12/20/2023]
Abstract
OBJECTIVES Strain on ICUs during the COVID-19 pandemic required stringent triage at the ICU to distribute resources appropriately. This could have resulted in reduced patient volumes, patient selection, and worse outcome of non-COVID-19 patients, especially during the pandemic peaks when the strain on ICUs was extreme. We analyzed this potential impact on the non-COVID-19 patients. DESIGN A national cohort study. SETTING Data of 71 Dutch ICUs. PARTICIPANTS A total of 120,393 patients in the pandemic non-COVID-19 cohort (from March 1, 2020 to February 28, 2022) and 164,737 patients in the prepandemic cohort (from January 1, 2018 to December 31, 2019). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Volume, patient characteristics, and mortality were compared between the pandemic non-COVID-19 cohort and the prepandemic cohort, focusing on the pandemic period and its peaks, with attention to strata of specific admission types, diagnoses, and severity. The number of admitted non-COVID-19 patients during the pandemic period and its peaks were, respectively, 26.9% and 34.2% lower compared with the prepandemic cohort. The pandemic non-COVID-19 cohort consisted of fewer medical patients (48.1% vs. 50.7%), fewer patients with comorbidities (36.5% vs. 40.6%), and more patients on mechanical ventilation (45.3% vs. 42.4%) and vasoactive medication (44.7% vs. 38.4%) compared with the prepandemic cohort. Case-mix adjusted mortality during the pandemic period and its peaks was higher compared with the prepandemic period, odds ratios were, respectively, 1.08 (95% CI, 1.05-1.11) and 1.10 (95% CI, 1.07-1.13). CONCLUSIONS In non-COVID-19 patients the strain on healthcare has driven lower patient volume, selection of fewer comorbid patients who required more intensive support, and a modest increase in the case-mix adjusted mortality.
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Affiliation(s)
- Sylvia Brinkman
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
| | - Fabian Termorshuizen
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- University Medical Center, University of Utrecht, Intensive Care Medicine, Utrecht, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Intensive Care Medicine, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bas C T van Bussel
- National Intensive Care Evaluation Foundation, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Centre +, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Di Girolamo C, Onorati R, Landriscina T, Gnavi R, Cesaroni G, Calandrini E, Bisceglia L, Fanizza C, Spadea T. Equity in the recovery of elective and oncological surgery volumes after the COVID-19 lockdown: a multicentre cohort study in Italy. Int J Equity Health 2024; 23:57. [PMID: 38491445 PMCID: PMC10943780 DOI: 10.1186/s12939-024-02127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/10/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has had, and still has, a profound impact on national health systems, altering trajectories of care and exacerbating existing inequalities in health. Postponement of surgeries and cancellation of elective surgical procedures have been reported worldwide. In Italy, the lock-down measures following the COVID-19 pandemic caused cancellations of surgical procedures and important backlogs; little is known about potential social inequalities in the recovery process that occurred during the post-lockdown period. This study aims at evaluating whether all population social strata benefited equally from the surgical volumes' recovery in four large Italian regions. METHODS This multicentre cohort study covers a population of approximately 11 million people. To assess if social inequalities exist in the recovery of eight indicators of elective and oncological surgery, we estimated Risk Ratios (RR) through Poisson models, comparing the incidence proportions of events recorded during COVID-19 (2020-21) with those in pre-pandemic years (2018-19) for each pandemic period and educational level. RESULTS Compared to 2018-19, volumes of elective surgery showed a U-shape with the most significant drops during the second wave or the vaccination phase. The recovery was socially unequal. At the end of 2021, incidence proportions among highly educated people generally exceeded the expected ones; RRs were 1.31 (95%CI 1.21-1.42), 1.24 (95%CI 1.17-1.23), 1.17 (95%CI 1.08-1.26) for knee and hip replacement and prostatic surgery, respectively. Among low educated patients, RR remained always < 1. Oncological surgery indicators showed a similar social gradient. Whereas volumes were preserved among the highly educated, the low educated were still lagging behind at the end of 2021. CONCLUSIONS Surgical procedures generally returned to pre-pandemic levels but the low educated experienced the slowest recovery. An equity-oriented appraisal of trends in healthcare provision should be included in pandemic preparedness plans, to ensure that social inequalities are promptly recognised and tackled.
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Affiliation(s)
- Chiara Di Girolamo
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole, 10, Orbassano (Turin), Italy.
- Regional Health and Social Care Agency Emilia-Romagna Region, Viale Aldo Moro, 21, Bologna, Italy.
| | - Roberta Onorati
- Epidemiology Unit, ASL TO3 Piedmont Region, Viale Sabaudia, 164, Grugliasco (Turin), Italy
| | - Tania Landriscina
- Epidemiology Unit, ASL TO3 Piedmont Region, Viale Sabaudia, 164, Grugliasco (Turin), Italy
| | - Roberto Gnavi
- Epidemiology Unit, ASL TO3 Piedmont Region, Viale Sabaudia, 164, Grugliasco (Turin), Italy
| | - Giulia Cesaroni
- Department of Epidemiology, Regional Health Service Lazio, Via Cristoforo Colombo, Rome, 112, Italy
| | - Enrico Calandrini
- Department of Epidemiology, Regional Health Service Lazio, Via Cristoforo Colombo, Rome, 112, Italy
| | - Lucia Bisceglia
- Regional Healthcare Agency of Puglia Region, Lungomare Nazario Sauro, Bari, 33, Italy
| | - Caterina Fanizza
- Regional Healthcare Agency of Puglia Region, Lungomare Nazario Sauro, Bari, 33, Italy
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3 Piedmont Region, Viale Sabaudia, 164, Grugliasco (Turin), Italy
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van Stein RM, Aronson SL, Sikorska K, Hendriks FJ, Hovinga EP, Houwink API, Schutte PFE, Schooneveldt MS, De Kroon CD, Sonke GS, van Driel WJ. Is routine admission to a critical care setting following hyperthermic intraperitoneal chemotherapy for ovarian cancer necessary? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107084. [PMID: 37812982 DOI: 10.1016/j.ejso.2023.107084] [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: 12/23/2022] [Revised: 07/17/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Hyperthermic intraperitoneal chemotherapy (HIPEC) is increasingly being used in patients with stage III ovarian cancer undergoing interval cytoreductive surgery (CRS). It is uncertain whether routine postoperative admission to a critical care setting after CRS-HIPEC is necessary. This study aims to estimate the incidence of patients requiring critical care, and to create a prediction model to identify patients who may forego admission to a critical care setting. METHODS We analyzed 154 patients with primary ovarian cancer undergoing interval CRS-HIPEC at two Dutch centers between 2007 and 2021. Patients were routinely admitted to a critical care setting for 12-24 h. Patients that received critical support as defined by pre-specified definitions were retrospectively identified. Logistic regression analysis with backward selection was used to predict the need for critical care and the model was validated using bootstrapping. RESULTS Thirty-eight percent of patients received postoperative critical care, consisting mainly of hemodynamic interventions. Independent predictors of critical care were blood loss, norepinephrine dose during surgery, and age (bootstrapped AUC = 0.76). Using a probability cut-off of 20%, one-third of patients are defined as low-risk for requiring critical care, with a negative predictive value of 0.88. CONCLUSIONS The majority of patients,primarily undergoing low to intermediate complexity surgeries, did not receive critical care interventions after CRS-HIPEC. Selective admission to a critical care setting may be warranted and its feasibility and safety needs to be evaluated prospectively. Our prediction model can help identify patients in whom admission to a critical care setting may be omitted. Hospital costs and burden on critical care units will benefit from patient selection.
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Affiliation(s)
- Ruby M van Stein
- Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - S Lot Aronson
- Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Dept. of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Karolina Sikorska
- Dept. of Biometrics Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Florine J Hendriks
- Dept. of Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Els P Hovinga
- Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Aletta P I Houwink
- Dept. of Anesthesiology and Intensive Care, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Peter F E Schutte
- Dept. of Anesthesiology and Intensive Care, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Maaike S Schooneveldt
- Dept. of Anesthesiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Cor D De Kroon
- Dept. of Gynecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands
| | - Gabe S Sonke
- Dept. of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Willemien J van Driel
- Dept. of Gynecologic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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5
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Doeve BH, Bakx JAC, Siersema PD, Rosman C, van Grieken NCT, van Berge Henegouwen MI, van Sandick JW, Verheij M, Bijlsma MF, Verhoeven RHA, van Laarhoven HWM. The impact of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer. J Gastroenterol 2023; 58:965-977. [PMID: 37523094 PMCID: PMC10522512 DOI: 10.1007/s00535-023-02009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has affected the entire global healthcare system, including oncological care. This study investigated the effects of the COVID-19 pandemic on the diagnosis, stage, and treatment of esophagogastric cancer in the Netherlands. METHODS Patients diagnosed in 2020 were divided into 5 periods, based on the severity of the COVID-19 pandemic in the Netherlands, and compared to patients diagnosed in the same period in the years 2017-2019. Patient characteristics and treatments were evaluated for esophageal cancer (EC) and gastric cancer (GC) separately. RESULTS The number of esophagogastric cancer diagnoses decreased prominently during the first 2 months of the COVID-19 pandemic. During this period, a significantly higher percentage of GC patients was diagnosed with incurable disease (52.5% in 2017-2019 and 67.7% in 2020, p = 0.011). We observed a significant reduction in the percentage of patients with potentially curable EC treated with resection and neoadjuvant chemoradiotherapy (from 35.0% in 2017-2019 to 27.3% in 2020, p < 0.001). Also, patients diagnosed with incurable GC were treated less frequently with a resection (from 4.6% in 2017-2019 to 1.5% in 2020, p = 0.009) in the second half of 2020. CONCLUSIONS Compared to previous years, the number of esophagogastric cancer diagnoses decreased in the first 2 months of the COVID-19 pandemic, while an increased percentage of patients was diagnosed with incurable disease. Both in the curative and palliative setting, patients were less likely to be treated with a surgical resection.
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Affiliation(s)
- Benthe H Doeve
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
- Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Oncode Institute, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Jeanne A C Bakx
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Nicole C T van Grieken
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC, Location Vrije Universteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark I van Berge Henegouwen
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Antoni Van Leeuwenhoek Hospital - Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands
| | - Maarten F Bijlsma
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Oncode Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Rob H A Verhoeven
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, Location University of Amsterdam, Meibergdreef 9, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Ioannou P, Maraki S, Koumaki D, Manios GA, Koumaki V, Kassotakis D, Zacharopoulos GV, Kofteridis DP, Manios A, de Bree E. A Six-Year Retrospective Study of Microbiological Characteristics and Antimicrobial Resistance in Specimens from a Tertiary Hospital’s Surgical Ward. Antibiotics (Basel) 2023; 12:antibiotics12030490. [PMID: 36978357 PMCID: PMC10044204 DOI: 10.3390/antibiotics12030490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Surgery has revolutionized the practice of medicine by allowing the treatment of conditions amenable to conservative medical management with some of them pathophysiologically involving the prevalence of pathogenic microorganisms. On the other hand, infections such as surgical site infections or urinary tract infections may complicate patients hospitalized in surgical wards leading to considerable morbidity, mortality, and increased healthcare-associated costs. The aim of this study was to present the microbiological characteristics and antimicrobial resistance of all isolates identified in microbiological specimens from a surgical ward of a tertiary hospital in Greece during a six-year period. Only specimens that yielded at least one microorganism were included in the analysis. In total, 1459 strains in 789 positive cultures were isolated. The most common sample sent to the microbiology department was pus from surgical wounds. The most common pathogens among all 1459 strains isolated were Enterobacterales at 33% (n = 482), however, the most common genus was Enterococcus at 22.3% (n = 326). Antimicrobial resistance against third-generation cephalosporins was 23% (n = 111/482) among Enterobacterales, while, the rate of vancomycin-resistant enterococci (VRE) was 18.5% (n = 60/324) among Enterococcus species and was increasing in the last years of the study. Antimicrobial resistance of Acinetobacter baumannii to carbapenems was 68.8% (n = 11/16), which was lower than the corresponding rate in other wards in Greece. The antimicrobial resistance rates noted herein raise questions regarding the appropriateness of currently suggested antimicrobials in guidelines and imply that a revision could be required. Practicing clinicians should always be aware of local microbiological data that allow the selection of appropriate antimicrobials for the management of infections. Finally, the increasing rates of VRE noted herein mandate further actions from the point of infection control and antimicrobial stewardship.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
- Correspondence:
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Dimitra Koumaki
- Department of Dermatology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios A. Manios
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 38221 Lamia, Greece
| | - Vasiliki Koumaki
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Dimitrios Kassotakis
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Andreas Manios
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Eelco de Bree
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Department of Surgical Oncology, University Hospital of Heraklion, 71110 Heraklion, Greece
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