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Sarıcaoğlu EM, Yörük F. Antimicrobial Susceptibility of Various MRSA Clinical Isolates and the Impact of Glycopeptide MICs on Clinical and Microbiological Outcomes. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2024; 6:102-111. [PMID: 39005705 PMCID: PMC11243782 DOI: 10.36519/idcm.2024.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/01/2024] [Indexed: 07/16/2024]
Abstract
Objective While vancomycin has remained the mainstay of the treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections, there is growing evidence of the clinical impact of increased glycopeptide minimum inhibitory concentrations (MICs) in MRSA isolates. This study aimed to determine the susceptibility of various MRSA isolates to different antibiotics with antistaphylococcal activity and the impact of glycopeptide MICs on clinical and microbiological outcomes. Materials and Methods This retrospective cohort study, conducted between 2013 and 2017, evaluated the susceptibility of MRSA strains isolated from various clinical samples to antistaphylococcal antibiotics using the gradient strip method. The clinical and laboratory features of patients infected with MRSA isolates with elevated glycopeptide MICs (>1 mg/L) and with isolates that had low glycopeptide MICs (≤1 mg/L) were compared. Results A total of 104 patients infected with MRSA strains were included in this study. Male sex (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.01-6.10, p=0.048), two or more comorbidities (OR=2.48, 95% CI=1.03-6.50, p=0.044), history of MRSA infection (OR=4.91, 95% CI=1.70-14.28, p=0.003) and a longer hospital stay prior to MRSA infection (OR=2.32, 95% CI=1.05-7.85, p=0.040) were independent risk factors for high glycopeptide MICs. In MRSA infections with a teicoplanin MIC of >0.75mg/L, the microbiological and treatment failures were 46.2% (p=0.044) and 60.6% (p=0.042), respectively. Conclusion This study showed that the critical MIC value, which suggested treatment failure as well as microbiological failure in the teicoplanin-treated MRSA infections, was >0.75 mg/L rather than >1 mg/L in our study cohort. The identification of high-risk patients;for treatment failures and mortality considering gradient strip method MIC values is crucial for the effective management of MRSA infections.
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Affiliation(s)
- Elif M Sarıcaoğlu
- Department of Infectious Disease and Clinical Microbiology, Ankara University School of Medicine, Ankara, Türkiye
| | - Fügen Yörük
- Department of Infectious Disease and Clinical Microbiology, Ankara University School of Medicine, Ankara, Türkiye
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Mayito J, Kibombo D, Olaro C, Nabadda S, Guma C, Nabukenya I, Busuge A, Dhikusooka F, Andema A, Mukobi P, Onyachi N, Watmon B, Obbo S, Yayi A, Elima J, Barigye C, Nyeko FJ, Mugerwa I, Sekamatte M, Bazira J, Walwema R, Lamorde M, Kakooza F, Kajumbula H. Characterization of Antibiotic Resistance in Select Tertiary Hospitals in Uganda: An Evaluation of 2020 to 2023 Routine Surveillance Data. Trop Med Infect Dis 2024; 9:77. [PMID: 38668538 PMCID: PMC11053536 DOI: 10.3390/tropicalmed9040077] [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: 01/29/2024] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance (AMR) is a public health concern in Uganda. We sought to conduct an extended profiling of AMR burden at selected Ugandan tertiary hospitals. We analyzed routine surveillance data collected between October 2020 and March 2023 from 10 tertiary hospitals. The analysis was stratified according to the hospital unit, age, gender, specimen type, and time. Up to 2754 isolates were recovered, primarily from pus: 1443 (52.4%); urine: 1035 (37.6%); and blood: 245 (8.9%). Most pathogens were Staphylococcus aureus, 1020 (37%), Escherichia coli, 808 (29.3%), and Klebsiella spp., 200 (7.3%). Only 28% of Escherichia coli and 42% of the other Enterobacterales were susceptible to ceftriaxone, while only 44% of Staphylococcus aureus were susceptible to methicillin (56% were MRSA). Enterococcus spp. susceptibility to vancomycin was 72%. The 5-24-year-old had 8% lower ampicillin susceptibility than the >65-year-old, while the 25-44-year-old had 8% lower ciprofloxacin susceptibility than the >65-year-old. The 0-4-year-old had 8% higher ciprofloxacin susceptibility. Only erythromycin susceptibility varied by sex, being higher in males. Escherichia coli ciprofloxacin susceptibility in blood (57%) was higher than in urine (39%) or pus (28%), as was ceftriaxone susceptibility in blood (44%) versus urine (34%) or pus (14%). Klebsiella spp. susceptibility to ciprofloxacin and meropenem decreased by 55% and 47%, respectively, during the evaluation period. During the same period, Escherichia coli ciprofloxacin susceptibility decreased by 40%, while Staphylococcus aureus gentamicin susceptibility decreased by 37%. Resistance was high across the Access and Watch antibiotic categories, varying with time, age, sex, specimen type, and hospital unit. Effective antimicrobial stewardship targeted at the critical AMR drivers is urgently needed.
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Affiliation(s)
- Jonathan Mayito
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Daniel Kibombo
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | | | | | | | - Immaculate Nabukenya
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Andrew Busuge
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Flavia Dhikusooka
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Alex Andema
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Peter Mukobi
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Nathan Onyachi
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Ben Watmon
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Stephen Obbo
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Alfred Yayi
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - James Elima
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Celestine Barigye
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | - Filbert J. Nyeko
- Regional Referral Hospital, Ministry of Health, Kampala P.O. Box 7272, Uganda; (A.A.); (P.M.)
| | | | | | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Richard Walwema
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Francis Kakooza
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala P.O. Box 22418, Uganda; (D.K.); (A.B.)
| | - Henry Kajumbula
- Department of Microbiology, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda;
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Swedan S, Alabdallah EA, Ababneh Q. Resistance to aminoglycoside and quinolone drugs among Klebsiella pneumoniae clinical isolates from northern Jordan. Heliyon 2024; 10:e23368. [PMID: 38163217 PMCID: PMC10757003 DOI: 10.1016/j.heliyon.2023.e23368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 11/09/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
This study aimed to identify phenotypic and genotypic aminoglycoside and quinolone non-susceptibility and the prevalence of aminoglycoside-modifying enzymes and plasmid-mediated quinolone resistance genes among K. pneumoniae clinical isolates from northern Jordan. K. pneumoniae isolates (n = 183) were tested for antimicrobial susceptibility using the Kirby-Bauer disk diffusion method. The double-disk synergy test was used for the detection of the extended-spectrum beta-lactamase phenotype. Polymerase chain reaction was used to detect genes encoding aminoglycoside-modifying enzyme (aac (3')-II, aac (6')-II, aac (6')-Ib, ant (3″)-I, aph (3')-VI, armA, and rmtB), and plasmid-mediated quinolone resistance (qnrA, qnrB, qnrC, qnrD, qnrS, acc(6')-Ib-cr, qepA, and oqxAB) genes. Multi-locus sequence typing was used to elucidate the genetic diversity of selected isolates. The non-susceptibility percentages to aminoglycosides and quinolones were 65.0 % and 61.7 %, respectively. The most frequent aminoglycoside-modifying enzyme gene was ant (3″)-I at 73.8 %, followed by aac (6')-Ib at 25.1 %, aac (3')-II at 17.5 %, aph (3')-VI at 12.0 %, armA at 9.8 %, and rmtB at 0.5 %. Aac (6')-II was not detected among the isolates. The most frequent plasmid-mediated quinolone resistance gene was oqxAB at 31.7 %, followed by qnrS at 26.2 %, qnrB at 25.7 %, and aac(6')-Ib-cr at 25.7 %. QnrA, qnrD, qebA, and qnrC were not detected among the isolates. Aac (3')-II, aac (6')-Ib, aph (3')-VI, armA, qnrB, qnrS, and acc(6')-Ib-cr were significantly associated with non-susceptibility to aminoglycosides, quinolones, and beta-lactams. Among 27 randomly selected K. pneumoniae isolates, the most common sequence type was ST2096, followed by ST348 and ST1207. Overall, 19 sequence types were observed, confirming a high level of genetic diversity among the isolates. High percentages of non-susceptibility to the studied antimicrobials were found and were associated with the presence of several resistance genes. Similar studies should be periodically carried out to monitor changes in the prevalence of resistance phenotypes and genotypes of isolates.
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Affiliation(s)
- Samer Swedan
- Faculty of Applied Medical Sciences, Dept. of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Emad Addin Alabdallah
- Faculty of Applied Medical Sciences, Dept. of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Qutaiba Ababneh
- Faculty of Science and Arts, Dept. of Biotechnology & Genetic Engineering, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Yap PSX, Chong CW, Ponnampalavanar S, Ramli R, Harun A, Tengku Jamaluddin TZM, Ahmed Khan A, Ngoi ST, Lee YQ, Lau MY, Tan SC, Kong ZX, Woon JJ, Mak ST, Abdul Jabar K, Karunakaran R, Ismail Z, Salleh SA, Md Noor SS, Masri SN, Mohd Taib N, Jasni AS, Tee LH, Leong KC, Lim VKE, Abu Bakar S, Teh CSJ. A multicentre study to determine the in vitro efficacy of flomoxef against extended-spectrum beta-lactamase producing Escherichia coli in Malaysia. PeerJ 2023; 11:e16393. [PMID: 38047021 PMCID: PMC10691355 DOI: 10.7717/peerj.16393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/11/2023] [Indexed: 12/05/2023] Open
Abstract
Background The high burden of extended-spectrum beta-lactamase-producing (ESBL)-producing Enterobacterales worldwide, especially in the densely populated South East Asia poses a significant threat to the global transmission of antibiotic resistance. Molecular surveillance of ESBL-producing pathogens in this region is vital for understanding the local epidemiology, informing treatment choices, and addressing the regional and global implications of antibiotic resistance. Methods Therefore, an inventory surveillance of the ESBL-Escherichia coli (ESBL-EC) isolates responsible for infections in Malaysian hospitals was conducted. Additionally, the in vitro efficacy of flomoxef and other established antibiotics against ESBL-EC was evaluated. Results A total of 127 non-repetitive ESBL-EC strains isolated from clinical samples were collected during a multicentre study performed in five representative Malaysian hospitals. Of all the isolates, 33.9% were isolated from surgical site infections and 85.8% were hospital-acquired infections. High rates of resistance to cefotaxime (100%), cefepime (100%), aztreonam (100%) and trimethoprim-sulfamethoxazole (100%) were observed based on the broth microdilution test. Carbapenems remained the most effective antibiotics against the ESBL-EC, followed by flomoxef. Antibiotic resistance genes were identified by PCR. The blaCTX-M-1 was the most prevalent ESBL gene, with 28 isolates (22%) harbouring blaCTX-M-1 only, 27 isolates (21.3%) co-harbouring blaCTX-M-1 and blaTEM, and ten isolates (7.9%) co-harbouring blaCTX-M-1, blaTEM and blaSHV. A generalised linear model showed significant antibacterial activity of imipenem against different types of infection. Besides carbapenems, this study also demonstrated a satisfactory antibacterial activity of flomoxef (81.9%) on ESBL-EC, regardless of the types of ESBL genes.
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Affiliation(s)
- Polly Soo Xi Yap
- Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | | | - Ramliza Ramli
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Azian Harun
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Anis Ahmed Khan
- School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Soo Tein Ngoi
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Yee Qing Lee
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Min Yi Lau
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shiang Chiet Tan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zhi Xian Kong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jia Jie Woon
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Siew Thong Mak
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rina Karunakaran
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zalina Ismail
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Sharifah Azura Salleh
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Siti Suraiya Md Noor
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Siti Norbaya Masri
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Azmiza Syawani Jasni
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | | | - Victor Kok Eow Lim
- School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Sazaly Abu Bakar
- Tropical Infectious Diseases Research and Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Ku JH, Bruxvoort KJ, Salas SB, Varley CD, Casey JA, Raphael E, Robinson SC, Nachman KE, Lewin BJ, Contreras R, Wei RX, Pomichowski ME, Takhar HS, Tartof SY. Multidrug Resistance of Escherichia coli From Outpatient Uncomplicated Urinary Tract Infections in a Large United States Integrated Healthcare Organization. Open Forum Infect Dis 2023; 10:ofad287. [PMID: 37426945 PMCID: PMC10326677 DOI: 10.1093/ofid/ofad287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 07/11/2023] Open
Abstract
Background Urinary tract infections (UTIs) cause significant disease and economic burden. Uncomplicated UTIs (uUTIs) occur in otherwise healthy individuals without underlying structural abnormalities, with uropathogenic Escherichia coli (UPEC) accounting for 80% of cases. With recent transitions in healthcare toward virtual visits, data on multidrug resistance (MDR) (resistant to ≥3 antibiotic classes) by care setting are needed to inform empiric treatment decision making. Methods We evaluated UPEC resistance over time by care setting (in-person vs virtual), in adults who received outpatient care for uUTI at Kaiser Permanente Southern California between January 2016 and December 2021. Results We included 174 185 individuals who had ≥1 UPEC uUTI (233 974 isolates) (92% female, 46% Hispanic, mean age 52 years [standard deviation 20]). Overall, prevalence of UPEC MDR decreased during the study period (13% to 12%) both in virtual and in-person settings (P for trend <.001). Resistance to penicillins overall (29%), coresistance to penicillins and trimethoprim-sulfamethoxazole (TMP-SMX) (12%), and MDR involving the 2 plus ≥1 antibiotic class were common (10%). Resistance to 1, 2, 3, and 4 antibiotic classes was found in 19%, 18%, 8%, and 4% of isolates, respectively; 1% were resistant to ≥5 antibiotic classes, and 50% were resistant to none. Similar resistance patterns were observed over time and by care setting. Conclusions We observed a slight decrease in both class-specific antimicrobial resistance and MDR of UPEC overall, most commonly involving penicillins and TMP-SMX. Resistance patterns were consistent over time and similar in both in-person and virtual settings. Virtual healthcare may expand access to UTI care.
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Affiliation(s)
- Jennifer H Ku
- Correspondence: Jennifer H. Ku, PhD, MPH, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101 ()
| | - Katia J Bruxvoort
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - S Bianca Salas
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Cara D Varley
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University-Portland State University, School of Public Health, Portland, Oregon, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Eva Raphael
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sarah C Robinson
- Center for Health Systems Research, Sutter Health, Walnut Creek, California, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bruno J Lewin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Kaiser Permanente Southern California and Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Richard Contreras
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Rong X Wei
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Magdalena E Pomichowski
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Harpreet S Takhar
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Gasser M, Cassini A, Lo Fo Wong D, Gelormini M, Nahrgang SA, Zingg W, Kronenberg AO. Associated deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in Switzerland, 2010 to 2019. Euro Surveill 2023; 28:2200532. [PMID: 37199988 PMCID: PMC10197493 DOI: 10.2807/1560-7917.es.2023.28.20.2200532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/21/2022] [Indexed: 05/19/2023] Open
Abstract
BackgroundCassini et al. (2019) estimated that, in 2015, infections with 16 different antibiotic-resistant bacteria resulted in ca 170 disability-adjusted life-years (DALYs) per 100,000 population in the European Union and European Economic area (EU/EEA). The corresponding estimate for Switzerland was about half of this (87.8 DALYs per 100,000 population) but still higher than that of several EU/EEA countries (e.g. neighbouring Austria (77.2)).AimIn this study, the burden caused by the same infections due to antibiotic-resistant bacteria ('AMR burden') in Switzerland from 2010 to 2019 was estimated and the effect of the factors 'linguistic region' and 'hospital type' on this estimate was examined.MethodsNumber of infections, DALYs and deaths were estimated according to Cassini et al. (2019) whereas separate models were built for each linguistic region/hospital type combination.ResultsDALYs increased significantly from 3,995 (95% uncertainty interval (UI): 3;327-4,805) in 2010 to 6,805 (95% UI: 5,820-7,949) in 2019. Linguistic region and hospital type stratifications significantly affected the absolute values and the slope of the total AMR burden estimates. DALYs per population were higher in the Latin part of Switzerland (98 DALYs per 100,000 population; 95% UI: 83-115) compared with the German part (57 DALYs per 100,000 population; 95% UI: 49-66) and in university hospitals (165 DALYs per 100,000 hospitalisation days; 95% UI: 140-194) compared with non-university hospitals (62 DALYs per 100,000 hospitalisation days; 95% UI: 53-72).ConclusionsThe AMR burden estimate in Switzerland has increased significantly between 2010 and 2019. Considerable differences depending on the linguistic region and the hospital type were identified - a finding which affects the nationwide burden estimation.
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Affiliation(s)
- Michael Gasser
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Alessandro Cassini
- Infection Prevention and Control Unit, Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- Deputy Cantonal Doctor, Public Health Department, Canton of Vaud, Lausanne, Switzerland
| | - Danilo Lo Fo Wong
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Marcello Gelormini
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Saskia Andrea Nahrgang
- Control of Antimicrobial Resistance Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Walter Zingg
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Oskar Kronenberg
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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Suwono B, Brandl M, Hecht J, Eckmanns T, Haller S. Epidemiology of healthcare-associated SARS-CoV-2 outbreaks in Germany between March 2020 and May 2022. J Hosp Infect 2023; 134:108-120. [PMID: 36738991 PMCID: PMC9894679 DOI: 10.1016/j.jhin.2023.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Outbreaks in healthcare facilities played a pivotal role in the course of the coronavirus (COVID-19) pandemic. AIM To investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks in hospitals, outpatient care, and rehabilitation facilities in Germany from March 2020 to May 2022. METHODS Data from the German mandatory notification system were used to describe outbreaks by number of cases and case fatality ratio (CFR), and outbreak cases by age and gender. Using Pearson correlation, the dynamics of cases in the general population were compared with cases in healthcare-associated infection (HAI) SARS-CoV-2 outbreaks before and after the start of the vaccination campaign. Additionally, a counterfactual scenario was used to estimate numbers of prevented HAI cases, using the phase before vaccination as baseline. FINDINGS By the end of May 2022, 8941 healthcare-associated outbreaks were observed with 73,626 cases: 51,504 in hospitals, 15,524 in outpatient care, and 6598 in rehabilitation facilities. Median number of cases per outbreak was 4 (range: 2-342) and cases were more frequently reported in women with 46,818 (63.6%). Overall CFR was 8.1%, higher in men (12.4%) than in women (5.7%). After the vaccination campaign was fully introduced, the association between increasing incidence in the general population and consecutive outbreak cases was decreased by a factor of 10. Furthermore, our counterfactual analysis suggests that more than 55,000 outbreak cases could have been prevented until the end of 2021. CONCLUSION The vaccination campaign in combination with non-pharmaceutical measures was key to reduce number, size and CFR of healthcare-associated outbreaks.
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Affiliation(s)
- B Suwono
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany.
| | - M Brandl
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - J Hecht
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - T Eckmanns
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
| | - S Haller
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Berlin, Germany
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Germany's Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant Enterococcus faecium between 2015-2020. Microorganisms 2022; 10:microorganisms10112273. [PMID: 36422343 PMCID: PMC9717732 DOI: 10.3390/microorganisms10112273] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/17/2022] Open
Abstract
In Germany, there is an increasing amount of vancomycin-resistant Enterococcus faecium (VREfm) isolates in bloodstream infections (BSIs); however, estimates on recent incidences and disease burden are missing. We aim to estimate the incidence and calculate the annual disease burden in disease-adjusted life years (DALYs) for BSIs due to VREfm in Germany between 2015 and 2020 to support informed decision-making in the field of antimicrobial resistance (AMR). We used the Antibiotic Resistance Surveillance (ARS) system data to obtain incidence estimates. The estimated incidences were used in the Burden of Communicable Disease in Europe (BCoDE) toolkit to calculate the attributable DALYs. A total of 3417 VREfm blood culture-positive isolates were observed within ARS. The estimated incidence of VREfm-BSIs per 100,000 inhabitants increased from 1.4 (95% Uncertainty Interval [UI]: 0.8−1.9) in 2015 to 2.9 (95% UI: 2.4−3.3) in 2020. The estimated burden, expressed in DALYs per 100,000 inhabitants, increased from 8.5 (95% UI: 7.3−9.7; YLD = 0.9, YLL = 7.6) in 2015 to 15.6 (95% UI: 14.6−16.6; YLD = 1.6, YLL = 14) in 2020. The most affected groups within the observed period are the 65−69-year-old males with 262.9 DALYs per 100,000 inhabitants, and in the younger age groups (<30 years), the under-one-year-old with 43.1 DALYs per 100,000 inhabitants and 34.5 DALYs for male and female, respectively. The increasing DALYs of BSIs due to VREfm require targeted prevention and control measures to address their unequal distribution across gender and age, especially for older hospitalized patients, neonates, and infants in Germany.
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Jones N, Mitchell J, Cooke P, Baral S, Arjyal A, Shrestha A, King R. Gender and Antimicrobial Resistance: What Can We Learn From Applying a Gendered Lens to Data Analysis Using a Participatory Arts Case Study? Front Glob Womens Health 2022; 3:745862. [PMID: 35720810 PMCID: PMC9199426 DOI: 10.3389/fgwh.2022.745862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance (AMR), the natural process by which bacteria become resistant to the medicines used to kill them, is becoming one of the greatest threats to health globally. AMR is accelerating at alarming rates due to behaviors across human, animal, and environmental health sectors as well as governance and policy shortfalls across each sector. Antimicrobial resistant infections occur through the same channels as other infectious diseases and are most common in countries/areas where there is limited access to improved sanitation facilities, reliable healthcare and health education. At the community level, much remains to be understood about the drivers of antimicrobial resistance and how to generate community-led, acceptable solutions. Gender can influence every part of an individual's health experiences; access to knowledge, healthcare facilities, financial resources and paid employment are all heavily gendered and influence behaviors relating to the procurement of antimicrobial and antibiotic agents. This analysis uses data gathered during a participatory video study designed to work with two communities in Nepal to understand drivers of antibiotic mis and over use from the perspective of the communities themselves. Findings reveal that gender impacts upon many aspects of AMR-driving behaviors within this community and stimulate essential discussion as to the importance of gender in future AMR research. This paper places a spotlight on gender in the wider AMR conversation, an area that is currently neglected, and improve our collective knowledge on the drivers of AMR from a gendered perspective.
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Affiliation(s)
- Nichola Jones
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Paul Cooke
- Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | | | | | | | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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Hammerl JA. Editorial for the Special Issue: “Antimicrobial Resistance and Molecular Tracing of Foodborne Pathogens”. Microorganisms 2022; 10:microorganisms10020390. [PMID: 35208845 PMCID: PMC8879549 DOI: 10.3390/microorganisms10020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/03/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jens André Hammerl
- Department Biological Safety, German Federal Institute for Risk Assessment, Max-Dohrn Str. 8-10, 10589 Berlin, Germany
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