Molecular epidemiology and clinical significance of carbapenemase genes in carbapenem-resistant Acinetobacter baumannii isolates in southern Poland.

INTRODUCTION: A complex interplay between Acinetobacter spp., patients, and the environment has made it increasingly difficult to optimally treat patients infected with Acinetobacter spp., mainly due to rising antimicrobial resistance and challenges with surveillance. OBJECTIVES: This study evaluated carbapenem­resistant A. baumannii (CRAB) isolates to determine their resistance profiles and the presence of specific ß­lactamases to inform CRAB surveillance upon hospital admission and regional empiric antibiotic therapies. PATIENTS AND METHODS: The study was conducted at 4 hospitals in southern Poland between June and December 2022. Only health care-associated infections caused by A. baumannii were considered. A total of 82 CRAB isolates were included in the analysis. Species identification was performed by matrix­assisted laser desorption / ionization time­of­flight mass spectrometry, antimicrobial susceptibility was determined phenotypically, and polymerase chain reactions were carried out to identify the resistance genes. RESULTS: Depending on the hospital, the incidence of CRAB infections varied from 428.6 to 759.5 per 10 000 admissions in intensive care units (ICUs), and from 0.3 to 21 per 10 000 admissions in non­ICUs. CRAB antibiotic susceptibility was the highest for cefiderocol (100%), colistin (96%), tigecycline (77%), gentamicin (51%), and ampicillin / sulbactam (36%). The most prevalent blaOXA genes were blaOXA­66­1 (95%) and blaOXA­40 (71%), and additionally the extended­spectrum ß­lactamase gene blaTEM­1 (41%). CONCLUSION: An unexpectedly high incidence of CRAB infections occurred in Polish hospitals. There is a need for effective CRAB prevention and control that includes effective hospital screening, national surveillance, and improved treatment options.

Re-evaluating the suitability of using fluoroquinolones in the treatment of infections in the context of FQ consumption and correlating changes to microorganism resistance levels in EU/EEA countries between 2016 and 2021.

The aim of this study was to re-evaluate fluoroquinolone (FQ) use in treatment by analyzing the consumption of FQ and the resistance levels of selected Gram­negative bacilli, as well as Neisseria gonorrhoeae and Mycobacterium tuberculosis complex in EU/EEA countries and in Poland between 2016 and 2021. Data from ECDC surveillance systems EARS-Net, Euro-GASP, and the European Tuberculosis Surveillance Network were included in the description of pathogen resistance. And the ESAC-Net project for determining FQ consumption. In over half of the EU/EEA countries, the consumption of fluoroquinolones decreased in both the community sector and the hospital sector between 2016 and 2021. The prevalence of FQ-R Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., Mycobacterium tuberculosis complex, and Neisseria gonorrhoeae exceeded 20%. The prevalence of fluoroquinolone-resistant (FQ-R) Pseudomonas aeruginosa in EU/EEA countries was less than 20% except for 2017. In most EU/EEA countries, the use of FQ has reduced in last years, except for countries like Poland where FQ were an overused group of antibiotics in the treatment of various types of infections. Fluoroquinolones, as life-saving antibiotics in severe infections, should be withdrawn from empirical treatment in Poland and in countries with a high prevalence of FQ-R microorganisms.

Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients.

BACKGROUND: Healthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients. METHODS: The study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases. RESULTS: The study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084-4.806), p < 0.001. CONCLUSIONS: Patients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.