The epidemiology and microbiological characteristics of infections caused by Gram-negative bacteria in Qatar: national surveillance from the Study for Monitoring of Antimicrobial Resistance Trends (SMART): 2017 to 2019

Antimicrobial activity of new anti-Pseudomonas beta-lactam-beta-lactamase inhibitors against Pseudomonas aeruginosa respiratory isolates recovered during the study for Monitoring Antimicrobial Resistance Trends (SMART) program in France (2016-2022)

OBJECTIVES

To assess the susceptibility of ceftolozane/tazobactam (C/T) and comparators to Pseudomonas aeruginosa isolates recovered from respiratory-tract-infections (RTI) between 2016-2022 in the French SMART study.

METHODS

Antibiotic susceptibility testing and minimum inhibitory concentrations (MICs) of 717 P.aeruginosa isolates collected in five French hospitals were determined and interpreted according to the EUCAST-2022 guidelines. P. aeruginosa isolates resistant (R) to imipenem and/or C/T were screened by PCR for extended-spectrum-β-lactamases (ESBLs), AmpC and carbapenemase genes. The identified genes were sequenced and the variants determined.

RESULTS

All in all, 96.5 % of P. aeruginosa isolates were susceptible to C/T, comparable to the susceptibilities of meropenem-vaborbactam (MVB = 96.5 %), imipenem/relebactam (IMI/REL = 96.9 %) and ceftazidime-avibactam (C/A = 97.0 %). MIC50 and MIC90 for C/T were 0.5 and 2 mg/L respectively against the 717 isolates. Among the 242 isolates (33.7 %) resistant to at least one anti-Pseudomonas β-lactam, close to 90 % were susceptible to C/T, C/A, MVB and IMI/REL. Among the 80 isolates resistant to piperacillin-tazobactam, cefepime and ceftazidime, 76.3 % were susceptible to C/T and only IMI/REL and amikacin reached susceptibility exceeding 80 %. Among the 32 isolates resistant to imipenem and meropenem, susceptibility exceeding 60 % was observed only for IMI/REL, C/T, and C/A. For these strains, the MIC50 of C/T was 2 mg/L, while that of C/A was at the resistance threshold (8 mg/L). IMI/REL had the strongest activity (72 %) against the 25 isolates resistant to C/T. Lastly, 53 imipenem and/or C/T-R isolates harbored a class C β-lactam (blaPDC) variant, and one of them also carried the blaPER-1 gene and another, the blaVIM-2 gene.

CONCLUSION

C/T is a reliable treatment option in RTI caused by P. aeruginosa.

The epidemiology of antimicrobial resistant bacterial infection in Qatar: A systematic review and meta-analysis

BACKGROUND

Antimicrobial resistance (AMR) is the current silent pandemic responsible for approximately five million deaths annually. According to the WHO, antimicrobial resistance is one of the top global public health threats and the third leading cause of death worldwide.

METHOD

This systematic review and meta-analyses aims to provide Qatar's first comprehensive epidemiological assessment of AMR. We conducted extensive search of three databases (PubMed, Embase and Web of Science) using broad search terms with no restrictions. The meta-analysis of prevalence was done using the Freeman-Turkey transformation and random effects models. Subgroup analysis was performed for three categories; the composite isolates, otherwise responsive isolates, and otherwise resistant isolates.

RESULTS

The search yielded a total of 1258 publications, of which 55 publications were included. The overall prevalence of all isolates was 13.64 % (95 %CI: 6.80 - 22.11, I2=99 %), all the studies were cross-sectional of convenience sampling, conducted in healthcare settings. The subgroup prevalence for the composite isolates was 8.87 % (95 %CI: 2.72 - 17.77, I2=98.7), otherwise responsive isolates was 11.37 % (95 %CI: 4.31 - 20.72, I2=98.3 %), otherwise resistant isolates was 23.55 % (95 %CI: 10.12 - 40.14, I2=99.1). The otherwise resistant isolates stratified analyses revealed that ESBL prevalence was 38.94 % (95 %CI: 21.63 - 57.79, I2=99.2 %), MDR was 15.99 % (95 %CI: 2.46 - 37.00, I2=99 %), MRSA was 52.37 % (95 %CI: 13.91 - 89.50, I2=88 %), Nosocomial infections prevalence was 23.55 % (95 %CI: 10.12 - 40.14, I2=98.2 %). The ESKAPE bacterial strains accounted for the majority of resistance.

CONCLUSION

Qatar's AMR overall prevalence is close to the global estimates, however the resistant isolates prevalence is higher than average according to the global estimates for high-income countries. The AMR public health response including national action plan to combat AMR and antimicrobial stewardship programs need to be orchestrated. AMR epidemiological research needs improvement in expanding coverage across diverse population groups to ensure greater clarity and precision in identifying bacterial infections and antibiotic classifications.

Development a risk prediction nomogram for multidrug-resistant bacterial and fungal infection in gastrointestinal fistula patients during the perioperative period

Background

This study aims to develop a risk prediction model for multidrug-resistant bacterial and fungal infections in patients with gastrointestinal fistulas during the perioperative period.

Methods

A retrospective cohort study was conducted at Anhui No. 2 Provincial People's Hospital from January 2022 to July 2024. We analyzed the distribution, resistance patterns, and mechanisms of multidrug resistance. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A nomogram was constructed based on these risk factors, and its performance was evaluated using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA).

Results

A total of 266 patients were included, with 157 (59.02%) testing positive for multidrug-resistant infections. We isolated 329 pathogenic strains: 84 Gram-positive (25.53%), 215 Gram-negative (65.35%), and 30 fungal strains (9.11%). The most common isolate was Klebsiella pneumoniae (57 strains, 17.33%). Patients were divided into a training cohort (n = 177) and a validation cohort (n = 89). Multivariate analysis identified six key indicators: secondary surgery, length of hospital stay, preoperative white blood cell (WBC) count, preoperative neutrophil count, postoperative WBC count, and postoperative C-reactive protein (CRP) levels. The nomogram demonstrated excellent predictive ability, with an area under the curve (AUC) of 0.905 in the training cohort and 0.793 in the validation cohort. Calibration curves indicated high consistency between predicted probabilities and observed values. DCA confirmed the clinical utility of the nomogram.

Conclusion

Our study shows that multidrug-resistant infections in patients with gastrointestinal fistulas are predominantly caused by Gram-negative bacilli, especially carbapenem-resistant Enterobacteriaceae. Key risk factors include secondary surgery and various blood count parameters. The developed nomogram provides robust predictive accuracy, aiding healthcare providers in implementing targeted infection prevention strategies.

Antimicrobial Resistance in Qatar: Prevalence and Trends before and Amidst the COVID-19 Pandemic

Antimicrobial resistance (AMR) is a global healthcare challenge with substantial morbidity, mortality, and management costs. During the COVID-19 pandemic, there was a documented increase in antimicrobial consumption, particularly for severe and critical cases, as well as noticeable travel and social restriction measures that might influenced the spectrum of AMR. To evaluate the problem, retrospective data were collected on bacterial infections and antimicrobial susceptibility patterns in Qatar before and after the pandemic from 1 January 2019 to 31 December 2021, covering 53,183 pathogens isolated from reported infection episodes. The findings revealed a significant resistance pattern for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-EBC), carbapenem-resistant Enterobacteriaceae (CR-EBC), and carbapenem-resistant Pseudomonas aeruginosa (CRPA), ciprofloxacin-resistant Salmonella and methicillin-resistant Staphylococcus aureus (MRSA). For correlation with social restrictions, ESBL-EBC and MRSA were positively correlated with changing patterns of international travel (ρ = 0.71 and 0.67, respectively; p < 0.05), while CRPA was moderately correlated with the number of COVID-19 hospitalized patients (ρ = 0.49; p < 0.05). CREBC and CRPA respiratory infections were associated with hospitalized patients (OR: 3.08 and 2.00, respectively; p < 0.05). The findings emphasize the challenges experienced during the COVID-19 pandemic and links to international travel, which probably will influence the local epidemiology of AMR that needs further surveillance and control strategies.

Antimicrobial surveillance: A 20-year history of the SMART approach to addressing global antimicrobial resistance into the future

Antimicrobial resistance (AMR) is a major global public health threat, particularly affecting patients in resource-poor settings. Comprehensive surveillance programmes are essential to reducing the high mortality and morbidity associated with AMR and are integral to informing treatment decisions and guidelines, appraising the effectiveness of intervention strategies, and directing development of new antibacterial agents. Various surveillance programmes exist worldwide, including those administered by government bodies or funded by the pharmaceutical industry. One of the largest and longest running industry-sponsored AMR surveillance programme is the Study for Monitoring Antimicrobial Resistance Trends (SMART), which recently completed its 20th year. The SMART database has grown to almost 500 000 isolates from over 200 sites in more than 60 countries, encompassing all major geographic regions and including many sites in low- and middle-income countries. The SMART surveillance programme has evolved in scope over time, including additional antibacterial agents, pathogens and infection sites, in line with changing epidemiology and medical need. Surveillance data from SMART and similar programmes have been used successfully to detect emerging resistance threats and AMR patterns in specific countries and regions, thus informing national and local clinical treatment guidelines. The SMART database can be accessed readily by physicians and researchers globally, which may be especially valuable to those from countries with limited healthcare resources, where surveillance and resistance data are rarely collected. Continued participation from as many sites as possible worldwide and maintenance of adequate funding are critical factors to fully realising the potential of large-scale AMR surveillance programmes into the future.