Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis

Clinical Microbiology and Infection, Journal Year: 2022, Volume and Issue: 29(3), P. 302 - 309

Published: Dec. 9, 2022

BackgroundCOVID-19 and antimicrobial resistance (AMR) are two intersecting global public health crises.ObjectiveWe aimed to describe the impact of COVID-19 pandemic on AMR across care settings.Data sourceA search was conducted in December 2021 WHO Research Database with forward citation searching up June 2022.Study eligibilityStudies evaluating any population were included influencing factors extracted. Reporting enhanced infection prevention control and/or stewardship programs noted.MethodsPooling done separately for Gram-negative Gram-positive organisms. Random-effects meta-analysis performed.ResultsOf 6036 studies screened, 28 23 provided sufficient data meta-analysis. The majority focused hospital settings (n = 25, 89%). not associated a change incidence density (incidence rate ratio 0.99, 95% CI: 0.67–1.47) or proportion (risk 0.91, 0.55–1.49) methicillin-resistant Staphylococcus aureus vancomycin-resistant enterococci cases. A non-statistically significant increase noted resistant organisms (i.e. extended-spectrum beta-lactamase, carbapenem-resistant Enterobacterales, carbapenem multi-drug Pseudomonas aeruginosa Acinetobacter baumannii, 1.64, 0.92–2.92; risk 1.08, 0.91–1.29). absence reported initiatives an gram-negative 1.11, 1.03–1.20). However, test subgroup differences showed no statistically difference between presence these (p 0.40).ConclusionThe may have hastened emergence transmission AMR, particularly settings. But there is considerable heterogeneity both metrics used studies. These findings reinforce need strengthened prevention, stewardship, surveillance context pandemic.

Language: Английский

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Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

The Lancet Microbe, Journal Year: 2023, Volume and Issue: 4(3), P. e179 - e191

Published: Feb. 1, 2023

BackgroundFrequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed establish the prevalence and predictors bacterial infections resistance COVID-19.MethodsWe did a systematic review meta-analysis studies co-infections (identified within ≤48 h presentation) secondary (>48 after outpatients or hospitalised COVID-19. searched WHO Research Database identify cohort studies, case series, case-control trials, randomised controlled trials populations at least 50 published any language between Jan 1, 2019, Dec 2021. Reviews, editorials, letters, pre-prints, conference proceedings were excluded, as which infection was not microbiologically confirmed (or via nasopharyngeal swab only). screened titles abstracts papers identified by our search, then assessed full text potentially relevant articles. reported pooled doing random-effects meta-regression. Our primary outcomes co-infection infection, antibiotic-resistant pathogens among laboratory-confirmed infections. The study protocol registered PROSPERO (CRD42021297344).FindingsWe included 148 362 976 patients, done December, May, 5·3% (95% CI 3·8–7·4), whereas 18·4% (14·0–23·7). 42 (28%) comprehensive data for Among people infections, proportion that resistant antimicrobials 60·8% 38·6–79·3), isolates 37·5% (26·9–49·5). Heterogeneity organisms substantial (I2=95%).InterpretationAlthough infrequently assessed, is highly prevalent Future research surveillance assessing effect on patient population level are urgently needed.FundingWHO.

Language: Английский

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Burden of infectious diseases and bacterial antimicrobial resistance in China: a systematic analysis for the global burden of disease study 2019

The Lancet Regional Health - Western Pacific, Journal Year: 2023, Volume and Issue: 43, P. 100972 - 100972

Published: Nov. 22, 2023

Infectious diseases and antimicrobial resistance (AMR) has become pressing concerns in China. We aimed to comprehensively investigate the burden of them.Data on infectious AMR were collected by Global Antimicrobial Resistance Burden study 2019. Multinomial network meta-regression, logistic regression, ensemble Spatiotemporal Gaussian process regression used fit number rate DisMod-MR 2.1 modelling framework. reported rates disease burdens 12 syndromes age sex; described caused 43 pathogens; estimated 22 bacteria bacteria-antibiotics combinations.There an 1.3 million (95% uncertainty intervals, UI 0.8-1.9) infection-related deaths, accounting for 12.1% total deaths China Males 1.5 times more affected than females. Bloodstream infections (BSIs) most lethal syndrome, associating with 521,392 (286,307-870,583), followed lower respiratory (373,175), peritoneal intra-abdominal (152,087). These five leading pathogens S aureus, A baumannii, E coli, pneumoniae, spp., which associated 41.2% (502,658/1,218,693) all deaths. The different exhibited significant heterogeneity. In 2019, 600 thousand AMR, including 145 attributable AMR. top 3 death carbapenems-resistance baumannii (18,143), methicillin-resistance aureus (16,933) third-generation cephalosporins-resistance coli (8032).Infectious bacterial serious threat public health China, related per-year, respectively. stewardship was urgent.This work supported National Natural Science Foundation (82270626); Mega-Project Diseases (2017ZX10203202, 2013ZX10002005); Project Beijing Technology Committee (Z191100007619037).

Language: Английский

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Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression

Clinical Microbiology and Infection, Journal Year: 2021, Volume and Issue: 28(4), P. 491 - 501

Published: Nov. 26, 2021

Language: Английский

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Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: Incidence, diagnosis and treatment

Journal of Microbiology Immunology and Infection, Journal Year: 2022, Volume and Issue: 55(6), P. 985 - 992

Published: Oct. 7, 2022

Coronavirus disease 2019 (COVID-19) emerged as a pandemic that spread rapidly around the world, causing nearly 500 billion infections and more than 6 million deaths to date. During first wave of pandemic, empirical antibiotics was prescribed in over 70% hospitalized COVID-19 patients. However, research now shows low incidence rate bacterial coinfection patients, between 2.5% 5.1%. The secondary 3.7% overall, but can be high 41.9% intensive care units. Over-prescription treat patients fueled ongoing antimicrobial resistance globally. Diagnosis is challenging due indistinguishable clinical presentations with overlapping lower respiratory tract symptoms such fever, cough dyspnea. Other diagnostic methods include conventional culture, syndromic testing, serology test biomarkers. or infection have higher in-hospital mortality longer length stay, timely appropriate antibiotic use aided by accurate diagnosis crucial improve patient outcome prevent resistance.

Language: Английский

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Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Oct. 18, 2022

Abstract Background The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 non-COVID-19 critically ill patients. Methods We used data from Eurobact II study, a prospective observational multicontinental cohort on HABSI treated in ICU. For current analysis, we selected centers that included both performed descriptive statistics terms patients’ characteristics, source infection microorganism distribution. studied association status mortality using multivariable fragility Cox models. Results A total 53 19 countries over 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) for HABSI. Included comprised 252 (30.4%) 577 (69.6%) time interval hospital admission was similar groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) primary (25.4% 17.2%, 0.006) more frequent had often enterococcal (20.5% 9%) Acinetobacter spp. (18.8% 13.6%) HABSIs. Bacteremic an increased hazard ratio (HR) versus (HR 1.91, 95% CI 1.49–2.45). Conclusions showed differed Enterococcal predominated with elevated risk mortality. Trial registration ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

Language: Английский

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Antibiotic-Resistant ESKAPE Pathogens and COVID-19: The Pandemic beyond the Pandemic

Viruses, Journal Year: 2023, Volume and Issue: 15(9), P. 1843 - 1843

Published: Aug. 30, 2023

Antibacterial resistance is a renewed public health plague in modern times, and the COVID-19 pandemic has rekindled this problem. Changes antibiotic prescribing behavior, misinformation, financial hardship, environmental impact, governance gaps have generally enhanced misuse improper access to antibiotics during pandemic. These determinants, intersected with antibacterial current pandemic, may amplify potential for future The occurrence of infections multidrug-resistant (MDR), extensively drug-resistant (XDR), difficult-to-treat (DTR), carbapenem-resistant (CR), pan-drug-resistant (PDR) bacteria still increasing. aim review highlight state art worldwide, focusing on most important pathogens, namely Enterobacterales, Acinetobacter baumannii, Klebsiella pneumoniae, their common antibiotics.

Language: Английский

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Incidence of bloodstream infections due to multidrug-resistant pathogens in ordinary wards and intensive care units before and during the COVID-19 pandemic: a real-life, retrospective observational study

Infection, Journal Year: 2023, Volume and Issue: 51(4), P. 1061 - 1069

Published: March 3, 2023

Abstract Purpose SARS-COV-2 pandemic led to antibiotic overprescription and unprecedented stress on healthcare systems worldwide. Knowing the comparative incident risk of bloodstream infection due multidrug-resistant pathogens in COVID ordinary wards intensive care-units may give insights into impact COVID-19 antimicrobial resistance. Methods Single-center observational data extracted from a computerized dataset were used identify all patients who underwent blood cultures January 1, 2018 May 15, 2021. Pathogen-specific incidence rates compared according time admission, patient’s status ward type. Results Among 14,884 for whom at least one culture was obtained, total 2534 diagnosed with HA-BSI. Compared both pre-pandemic COVID-negative wards, HA-BSI S. aureus Acinetobacter spp . (respectively 0.3 [95% CI 0.21–0.32] 0.11 [0.08–0.16] new infections per 100 patient-days) showed significantly higher rates, peaking COVID-ICU setting. Conversely, E. coli 48% lower COVID-positive vs settings (IRR 0.53 [0.34–0.77]). + patients, ( n = 38/79) isolates resistant methicillin 40% 10/25) K. pneumoniae carbapenems. Conclusions The presented here indicate that spectrum causing BSI care units varied during pandemic, greatest shift experienced by COVID-ICUs. Antimicrobial resistance selected high-priority bacteria high positive settings.

Language: Английский

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Impact of Multidrug-Resistant Bacteria in a Cohort of COVID-19 Critically Ill Patients: Data from a Prospective Observational Study Conducted in a High-Antimicrobial-Resistance-Prevalence Center

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(2), P. 410 - 410

Published: Jan. 10, 2025

Background: Bacterial superinfections are common complications during viral infections, but the impact of multidrug-resistant (MDR) pathogens in critically ill patients affected by coronavirus disease 2019 (COVID-19) is still debated. Methods: This an observational, monocentric, and prospective study designed to investigate incidence, risk factors, outcomes MDR bacterial COVID-19 admitted intensive care unit (ICU). Results: A high incidence (66%, 159/241) was observed: ventilator-associated pneumonia (VAP) (65%, 104/159) bloodstream infection (BSI, 32%, 51/159) were most common. Superinfections, Extra-Corporeal Membrane Oxygenation (ECMO) support, prone positioning increased death five, four, more-than-two times, respectively (OR = 5.431, IC 95%: 1.637-18.014; 4.462, 1.616-12.324 2.346, 1.127-4.883). bacteria identified 61% with superinfection, a cumulative 37.2% at day 14. Carbapenem-resistant Acinetobacter baumannii (CR-AB) CR-Klebsiella pneumoniae (CR-KP) causative agents (24.3% 13.7%). CR-AB found significantly increase both ICU in-hospital mortality (76.4% 78.2%), whereas CR-KP had no direct on mortality. Prior rectal colonization (p < 0.0001), mechanical ventilation 0.0017), prolonged stay use iNO 0.0082), vasopressors 0.0025), curarization 0.0004), 0.0084) be factors for CR-AB. Conclusions: Critically developing superinfection. While mortality, appeared

Language: Английский

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Update on Staphylococcus aureus bacteraemia

Current Opinion in Critical Care, Journal Year: 2022, Volume and Issue: 28(5), P. 495 - 504

Published: Aug. 4, 2022

Purpose of review To recently published evidence relevant to Staphylococcus aureus bacteremia (SAB). Recent findings is the most common pathogen causing co-infections and superinfections in patients with COVID-19. Methicillin-resistant (MRSA) ratios have sharply risen during pandemic. SAB mortality 18% at 1 month 27% 3 months but has gradually decreased over last 30 years. Recurrences reinfections are (9%). Standardised items define complicated SAB, a new cut-off defining persisting after 2 days positive blood cultures been proposed. Multiple antibiotic combinations trialled including vancomycin or daptomycin β-lactams, fosfomycin, clindamycin, without significant results. In guidelines, remains first line treatment for MRSA bacteremia. For management methicillin-susceptible , cefazolin less frequently causes acute kidney injury than flucloxacillin, when susceptibility demonstrated, de-escalation penicillin G suggested. Summary Our confirms that represents special aetiology among all bloodstream infections. Pending results platform larger trials, its distinct epidemiology determinants mandate careful integration clinical variables best available optimize patient outcomes.

Language: Английский

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