SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS
Intro: This study aimed at evaluating healthcare-related sepses caused by three multi-drug resistant Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital in 2018-2020, particularly concerning therapy, antibiotic-resistance and outc...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-05-01
|
| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971223004241 |
| _version_ | 1797824599960846336 |
|---|---|
| author | J. Garlasco C. Bolla I. Beqiraj E. Marino C. Zanelli C. Gualco A. Rocchetti C. Zotti M. Gianino |
| author_facet | J. Garlasco C. Bolla I. Beqiraj E. Marino C. Zanelli C. Gualco A. Rocchetti C. Zotti M. Gianino |
| author_sort | J. Garlasco |
| collection | DOAJ |
| description | Intro: This study aimed at evaluating healthcare-related sepses caused by three multi-drug resistant Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital in 2018-2020, particularly concerning therapy, antibiotic-resistance and outcomes, by also comparing the pre-COVID (2018-2019) and COVID (2020) periods. Methods: An observational, retrospective-cohort analysis was based on data related to patients admitted to the “SS. Antonio e Biagio e Cesare Arrigo” Hospital in Alessandria (Italy) between 2018 and 2020, with septic episodes from bacteria of the examined species, whose antibiogram proved resistance to ≥ 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients’ medical records and the hospital's computer-based application. Statistics involved Fisher-test comparisons and cumulative incidence analyses. Findings: Inclusion criteria led to enrolment of 174 patients. Comparison between 2020 and 2018-2019 showed a relative increase in A. baumannii cases, at the expense of the other species (p<0.0001), and an increasing resistance trend for K. pneumoniae, with a higher proportion of cases resistant to 3-4 classes of antimicrobials (p<0.0001). Overall, most patients were treated with carbapenems (72.4%), although the COVID period saw a significant rise in the use of polymyxins, particularly colistin (62.5% vs 36%, p=0.0005). In both periods, more than half patients recovered (53-57%) and around one third died (27-34%), but with different outcomes according to the infecting bacterium, generally better for P. aeruginosa (70% recovered at 60 days) and worse for A. baumannii (55% recovered). Discussion: The study confirmed the importance of the burden connected to healthcare-related sepses. Moreover, since the COVID outbreak, a trend could be spotted towards higher relative incidence of complex cases, caused by antimicrobial-resistant bacteria and thus requiring second-line therapy. Conclusion: These findings underline the importance of appropriate antimicrobial stewardship and infection control in view of the evolving healthcare needs. |
| first_indexed | 2024-03-13T10:41:22Z |
| format | Article |
| id | doaj.art-c948acd2c05e455f899b68fb63a5e5e8 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-03-13T10:41:22Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-c948acd2c05e455f899b68fb63a5e5e82023-05-18T04:38:56ZengElsevierInternational Journal of Infectious Diseases1201-97122023-05-01130S119S120SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONSJ. Garlasco0C. Bolla1I. Beqiraj2E. Marino3C. Zanelli4C. Gualco5A. Rocchetti6C. Zotti7M. Gianino8University of Turin, Department of Public Health Sciences and Paediatrics, Turin, ItalySS. Antonio e Biagio e Cesare Arrigo Hospital, Department of Infectious Diseases, Alessandria, ItalySS. Antonio e Biagio e Cesare Arrigo Hospital, Intensive Care Unit, Alessandria, ItalySS. Antonio e Biagio e Cesare Arrigo Hospital, Department of Infection Prevention and Control, Alessandria, ItalySS. Antonio e Biagio e Cesare Arrigo Hospital, Department of Quality and Management Control, Alessandria, ItalySS. Antonio e Biagio e Cesare Arrigo Hospital, Department of Quality and Management Control, Alessandria, ItalySS. Antonio e Biagio e Cesare Arrigo Hospital, Department of Microbiology, Alessandria, ItalyUniversity of Turin, Department of Public Health Sciences and Paediatrics, Turin, ItalyUniversity of Turin, Department of Public Health Sciences and Paediatrics, Turin, ItalyIntro: This study aimed at evaluating healthcare-related sepses caused by three multi-drug resistant Gram-negative bacteria (Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) in a tertiary hospital in 2018-2020, particularly concerning therapy, antibiotic-resistance and outcomes, by also comparing the pre-COVID (2018-2019) and COVID (2020) periods. Methods: An observational, retrospective-cohort analysis was based on data related to patients admitted to the “SS. Antonio e Biagio e Cesare Arrigo” Hospital in Alessandria (Italy) between 2018 and 2020, with septic episodes from bacteria of the examined species, whose antibiogram proved resistance to ≥ 2 antimicrobial classes indicated by the European Centre for Disease Prevention and Control. Data were retrieved from patients’ medical records and the hospital's computer-based application. Statistics involved Fisher-test comparisons and cumulative incidence analyses. Findings: Inclusion criteria led to enrolment of 174 patients. Comparison between 2020 and 2018-2019 showed a relative increase in A. baumannii cases, at the expense of the other species (p<0.0001), and an increasing resistance trend for K. pneumoniae, with a higher proportion of cases resistant to 3-4 classes of antimicrobials (p<0.0001). Overall, most patients were treated with carbapenems (72.4%), although the COVID period saw a significant rise in the use of polymyxins, particularly colistin (62.5% vs 36%, p=0.0005). In both periods, more than half patients recovered (53-57%) and around one third died (27-34%), but with different outcomes according to the infecting bacterium, generally better for P. aeruginosa (70% recovered at 60 days) and worse for A. baumannii (55% recovered). Discussion: The study confirmed the importance of the burden connected to healthcare-related sepses. Moreover, since the COVID outbreak, a trend could be spotted towards higher relative incidence of complex cases, caused by antimicrobial-resistant bacteria and thus requiring second-line therapy. Conclusion: These findings underline the importance of appropriate antimicrobial stewardship and infection control in view of the evolving healthcare needs.http://www.sciencedirect.com/science/article/pii/S1201971223004241 |
| spellingShingle | J. Garlasco C. Bolla I. Beqiraj E. Marino C. Zanelli C. Gualco A. Rocchetti C. Zotti M. Gianino SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS International Journal of Infectious Diseases |
| title | SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS |
| title_full | SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS |
| title_fullStr | SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS |
| title_full_unstemmed | SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS |
| title_short | SEPTIC EPISODES CAUSED BY ACINETOBACTER BAUMANNII, KLEBSIELLA PNEUMONIAE AND PSEUDOMONAS AERUGINOSA IN A TERTIARY HOSPITAL IN 2018-2020: TRENDS AND CONSIDERATIONS |
| title_sort | septic episodes caused by acinetobacter baumannii klebsiella pneumoniae and pseudomonas aeruginosa in a tertiary hospital in 2018 2020 trends and considerations |
| url | http://www.sciencedirect.com/science/article/pii/S1201971223004241 |
| work_keys_str_mv | AT jgarlasco septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT cbolla septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT ibeqiraj septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT emarino septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT czanelli septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT cgualco septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT arocchetti septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT czotti septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations AT mgianino septicepisodescausedbyacinetobacterbaumanniiklebsiellapneumoniaeandpseudomonasaeruginosainatertiaryhospitalin20182020trendsandconsiderations |