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Amodio E, Pizzo S, Vella G, De Francisci V, Distefano SA, Giambelluca E, Graceffa D, Verso MG, Piro E, Giuffrè M, Giammanco GM, Calamusa G. Increase of multidrug-resistant bacteria after the COVID-19 pandemic in a major teaching Hospital in Sicily (2018-2021). Int J Antimicrob Agents 2024; 63:107123. [PMID: 38408493 DOI: 10.1016/j.ijantimicag.2024.107123] [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: 09/08/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION The COVID-19 pandemic has further highlighted the continuing threat of antimicrobial resistance (AMR) to global health and economic development. In the last two decades, AMR has raised increasing concern, with an estimated 4.95 million deaths globally due to bacterial AMR in 2019 alone. The aim of this study was to analyse the impact of the pandemic on the spread of multidrug-resistant organisms (MDROs) using data from the Hospital "P. Giaccone" in Palermo, comparing pre-pandemic and pandemic periods. METHODS This observational study involved adult patients who were discharged from the hospital between 01 January 2018 and 31 December 2021. Hospital Discharge Cards were linked with microbiological laboratory reports to assess MDRO isolations. SARS-CoV-2 positivity during hospitalisation was evaluated using the National Institute of Health surveillance system. RESULTS A total of 58 427 hospitalisations were evaluated in this study. Half the patients were aged over 65 years (N=26 984) and most admissions were in the medical area (N=31 716). During the hospitalisation period, there were 2681 patients (5%) with MDROs isolations, and 946 patients (2%) were positive for SARS-CoV-2. Multivariable analyses showed that during 2020 and 2021, there was a significantly increased risk of isolation of Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Age, weight of the Diagnosis-Related Group (DRG), wards with higher intensity of care, and length-of-stay were associated with a higher risk of MDRO isolation. CONCLUSION This study provides new insights into the impact of the COVID-19 pandemic on MDRO isolation and has important implications for infection control and prevention efforts in healthcare facilities. Age, DRG-weight, and longer hospital stays further increased the risk of MDRO isolation. Thus, it is imperative to improve and follow hospital protocols to prevent healthcare-associated infections.
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Affiliation(s)
- Emanuele Amodio
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Stefano Pizzo
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Giuseppe Vella
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy.
| | - Valerio De Francisci
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Salvatore Antonino Distefano
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Eliana Giambelluca
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Domenico Graceffa
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Maria Gabriella Verso
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Ettore Piro
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Mario Giuffrè
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Giovanni Maurizio Giammanco
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
| | - Giuseppe Calamusa
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties «G. D'Alessandro», Via del Vespro 133, 90127, Palermo, Italy
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Wang Y, Zhang J, Chen X, Sun M, Li Y, Wang Y, Gu Y, Cai Y. Development and Validation of a Nomogram Prediction Model for Multidrug-Resistant Organisms Infection in a Neurosurgical Intensive Care Unit. Infect Drug Resist 2023; 16:6603-6615. [PMID: 37840828 PMCID: PMC10573443 DOI: 10.2147/idr.s411976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Objective To develop a predictive model for assessing the risk of multidrug-resistant organisms (MDROs) infection and validate its effectiveness. We conducted a study on a total of 2516 patients admitted to the neurosurgery intensive care unit (NICU) of a Grade-III hospital in Nantong City, Jiangsu Province, China, between January 2014 and February 2022. Patients meeting the inclusion criteria were selected using convenience sampling. The patients were randomly divided into modeling and validation groups in a 7:3 ratio. To address the category imbalance, we employed the Synthetic Minority Over-sampling Technique (SMOTE) to adjust the MDROs infection ratio from 203:1558 to 812:609 in the training set. Univariate analysis and logistic regression analysis were performed to identify risk factors associated with MDROs infection in the NICU. A risk prediction model was developed, and a nomogram was created. Receiver operating characteristic (ROC) analysis was used to assess the predictive performance of the model. Patients and Methods Results Logistic regression analysis revealed that sex, hospitalization time, febrile time, invasive operations, postoperative prophylactic use of antibiotics, mechanical ventilator time, central venous catheter indwelling time, urethral catheter indwelling time, ALB, PLT, WBC, and L% were independent predictors of MDROs infection in the NICU. The area under the ROC curve for the training set and validation set were 0.880 (95% CI: 0.857-0.904) and 0.831 (95% CI: 0.786-0.876), respectively. The model's prediction curve closely matched the ideal curve, indicating excellent predictive performance. Conclusion The prediction model developed in this study demonstrates good accuracy in assessing the risk of MDROs infection. It serves as a valuable tool for neurosurgical intensive care practitioners, providing an objective means to effectively evaluate and target the risk of MDROs infection.
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Affiliation(s)
- Ya Wang
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Jiajia Zhang
- Neurosurgery Section Two, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Xiaoyan Chen
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Min Sun
- Department of Geriatrics Section Three, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yanqing Li
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yanan Wang
- Respiratory and Critical Care Medicine Intensive Care Unit, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yan Gu
- Infection Management Office, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
| | - Yinyin Cai
- Neurosurgical Intensive Care Unit, Department of Neurosurgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China
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