ABSTRACT
We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May-June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.
Subject(s)
Anti-Bacterial Agents , COVID-19 , Critical Illness , Gram-Negative Bacteria , Infection Control , Practice Patterns, Nurses' , Superinfection , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Critical Illness/epidemiology , Critical Illness/therapy , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Humans , Infection Control/methods , Infection Control/organization & administration , Intensive Care Units/organization & administration , Maryland/epidemiology , Microbiological Techniques/methods , Microbiological Techniques/statistics & numerical data , Practice Patterns, Nurses'/organization & administration , Practice Patterns, Nurses'/standards , Precipitating Factors , Risk Factors , SARS-CoV-2 , Superinfection/diagnosis , Superinfection/microbiologyABSTRACT
BackgroundAntimicrobial resistance (AMR) changes over time and continuous monitoring provides insight on trends to inform both empirical treatment and public health action.AimsTo survey trends in relative isolation frequency (RIF) and AMR among key bloodstream pathogens using data from the Greek Electronic System for the Surveillance of AMR (WHONET-Greece).MethodsThis observational study looked into routine susceptibility data of 50,488 blood culture isolates from hospitalised patients in 25 tertiary hospitals, participating in the WHONET-Greece for trends over time between January 2010 and December 2017. Only the first isolate per species from each patient was included. Hospital wards and intensive care units (ICUs) were analysed separately.ResultsDuring the study, the RIF of Acinetobacter baumannii increased in wards, as did the proportion of A. baumannii isolates, which were non-susceptibleto most antibiotics in both wards and ICUs. Coincidently, Klebsiella pneumoniae RIF declined while the respective rates of non-susceptible isolates to carbapenems and gentamicin increased. Pseudomonas aeruginosa RIF remained stable but decreasing proportions of non-susceptible isolates to all studied antibiotics, except imipenem were observed. Escherichia coli RIF increased as did the proportion of isolates non-susceptible to third-generation cephalosporins, carbapenems and fluoroquinolones. Concerning Staphylococcus aureus, a decline in the percentage of meticillin resistant isolates in ICUs was found, while the percentages of Enterococcus faecium isolates with non-susceptibility to vancomycin stayed stable.ConclusionsRecognising these trends over time is important, since the epidemiology of AMR is complex, involving different 'bug and drug' combinations. This should be taken into consideration to control AMR.