Prevalence and Antimicrobial Resistance Trends among Lower Respiratory Tract Pathogens in Crete, Greece, 2017-2022
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background Lower respiratory tract infections (LRTIs) are the most common infections in humans accounting for significant morbidity and mortality. Management of LRTIs is complicated due to increasing antimicrobial resistance. This study investigated the prevalence and trends of antimicrobial resistance for bacteria isolated from respiratory samples of patients with LRTIs. Materials and Methods Sputum and bronchial washings were collected from patients of all ages hospitalized with LRTIs and were analyzed by the microbiological laboratory in the University Hospital of Heraklion, Crete, Greece, from January 2017 to December 2022. Identification of the bacterial isolates was performed by matrix-assisted laser desorption ionization-time of flight mass spectrometry and antimicrobial susceptibility testing by Vitek 2 system. Results A total of 4,008 strains were isolated from 3,427 respiratory samples. Acinetobacter baumannii was the most frequently isolated pathogen (23.1%), followed by Pseudomonas aeruginosa (20.0%), Staphylococcus aureus (10.6%) and Klebsiella pneumoniae (6.8%). The isolation rate of A. baumannii significantly increased during the study period, while there were lower increases in the isolation rates of P. aeruginosa, K. pneumoniae and S. aureus. A. baumannii and P. aeruginosa were more prevalent during summer, K. pneumoniae was more common during autumn, while for S. aureus higher incidence was noted during winter. A. baumannii exhibited high resistance rates (≥90.0%) to most of the antimicrobial agents tested, and extremely high multidrug-resistance (91.0%). P. aeruginosa showed the lowest rate of resistance for colistin (1.4%). Among β-lactams, resistance rates to piperacillin/tazobactam, ceftazidime, cefepime, imipenem and meropenem were 26.2%, 27%, 25.8%, 29.2% and 29.9%, respectively. A total of 162 (68.1%) meropenem-resistant P. aeruginosa were simultaneously resistant to ceftazidime and piperacillin/tazobactam. Regarding K. pneumoniae, high rates of resistance were observed for the third and fourth generation cephalosporins, namely cefotaxime, ceftriaxone, ceftazidime, and cefepime and the carbapenems, imipenem and meropenem ranging from 46.2% to 53.8%. Carbapenem-resistance was detected among 46.2% of the isolates. Among the 126 carbapenem-resistant K. pneumoniae isolates, 83 (65.9%), 30 (23.8%), 9 (7.2%), and 4 (4.2%) were positive for Klebsiella pneumoniae carbapenemase, New Delhi Metallo-β-lactamase, Verona Integron-Mediated Metallo-β-lactamase and OXA-48 carbapenemase, respectively. Of the total number of S. aureus, 37.2% were methicillin resistant. Low rates of resistance were detected in trimethoprim/sulfamethoxazole (3.3%), gentamicin (2.8%), and rifampicin (0.9%). All isolates were susceptible to linezolid, daptomycin, tigecycline, teicoplanin, and vancomycin. Conclusion Regularly updated surveillance of local microbial prevalence and monitoring of antimicrobial resistance patterns is of paramount importance to guide the empiric treatment of LRTIs.
Abstract
Background Lower respiratory tract infections (LRTIs) are the most common infections in humans accounting for significant morbidity and mortality. Management of LRTIs is complicated due to increasing antimicrobial resistance. This study investigated the prevalence and trends of antimicrobial resistance for bacteria isolated from respiratory samples of patients with LRTIs. Materials and Methods Sputum and bronchial washings were collected from patients of all ages hospitalized with LRTIs and were analyzed by the microbiological laboratory in the University Hospital of Heraklion, Crete, Greece, from January 2017 to December 2022. Identification of the bacterial isolates was performed by matrix-assisted laser desorption ionization-time of flight mass spectrometry and antimicrobial susceptibility testing by Vitek 2 system. Results A total of 4,008 strains were isolated from 3,427 respiratory samples. Acinetobacter baumannii was the most frequently isolated pathogen (23.1%), followed by Pseudomonas aeruginosa (20.0%), Staphylococcus aureus (10.6%) and Klebsiella pneumoniae (6.8%). The isolation rate of A. baumannii significantly increased during the study period, while there were lower increases in the isolation rates of P. aeruginosa, K. pneumoniae and S. aureus. A. baumannii and P. aeruginosa were more prevalent during summer, K. pneumoniae was more common during autumn, while for S. aureus higher incidence was noted during winter. A. baumannii exhibited high resistance rates (≥90.0%) to most of the antimicrobial agents tested, and extremely high multidrug-resistance (91.0%). P. aeruginosa showed the lowest rate of resistance for colistin (1.4%). Among β-lactams, resistance rates to piperacillin/tazobactam, ceftazidime, cefepime, imipenem and meropenem were 26.2%, 27%, 25.8%, 29.2% and 29.9%, respectively. A total of 162 (68.1%) meropenem-resistant P. aeruginosa were simultaneously resistant to ceftazidime and piperacillin/tazobactam. Regarding K. pneumoniae, high rates of resistance were observed for the third and fourth generation cephalosporins, namely cefotaxime, ceftriaxone, ceftazidime, and cefepime and the carbapenems, imipenem and meropenem ranging from 46.2% to 53.8%. Carbapenem-resistance was detected among 46.2% of the isolates. Among the 126 carbapenem-resistant K. pneumoniae isolates, 83 (65.9%), 30 (23.8%), 9 (7.2%), and 4 (4.2%) were positive for Klebsiella pneumoniae carbapenemase, New Delhi Metallo-β-lactamase, Verona Integron-Mediated Metallo-β-lactamase and OXA-48 carbapenemase, respectively. Of the total number of S. aureus, 37.2% were methicillin resistant. Low rates of resistance were detected in trimethoprim/sulfamethoxazole (3.3%), gentamicin (2.8%), and rifampicin (0.9%). All isolates were susceptible to linezolid, daptomycin, tigecycline, teicoplanin, and vancomycin. Conclusion Regularly updated surveillance of local microbial prevalence and monitoring of antimicrobial resistance patterns is of paramount importance to guide the empiric treatment of LRTIs.
참고문헌 (34)
- Malakounidou E, "Lower respiratory tract infections treatment recommendations : an overview", Pneumon, 36, pp.17~ (2023)
- Safiri S, "Global burden of lower respiratory infections during the last three decades", Front Public Health, 10, pp.1028525~ (2023)
- GBD 2021 Causes of Death Collaborators, "Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021 : a systematic analysis for the Global Burden of Disease Study 2021", Lancet, 403, pp.2100~2132 (2024)
- Lampropoulos IC, "Trends in mortality from lower respiratory tract infections in Greece (1998-2015)", Eur Respir J, 58(Suppl 65), pp.PA1751~ (2021)
- Kashatnikova DA, "Pneumonia and related conditions in critically Ill patients-insights from basic and experimental studies", Int J Mol Sci, 23, pp.9896~ (2022)
- Maraki S, "Antimicrobial resistance trends among community-acquired respiratory tract pathogens in Greece, 2009-2012", ScientificWorldJournal, 2014, pp.941564~ (2014)
- Kofteridis DP, "Nosocomial lower respiratory tract infections : prevalence and risk factors in 14 Greek hospitals", Eur J Clin Microbiol Infect Dis, 23, pp.888~891 (2004)
- "Breakpoint tables for interpretation for MICs and zone diameters: version 10.0, valid from 2020-01-01"[URL]
- Clinical and Laboratory Standards Institute (CLSI), "Performance standards for antimicrobial susceptibility testing" (2022), CLSI
- Magiorakos AP, "Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria : an international expert proposal for interim standard definitions for acquired resistance", Clin Microbiol Infect, 18, pp.268~281 (2012)
- Poirel L, "Multiplex PCR for detection of acquired carbapenemase genes", Diagn Microbiol Infect Dis, 70, pp.119~123 (2011)
- Santella B, "Lower respiratory tract pathogens and their antimicrobial susceptibility pattern : a 5-year study", Antibiotics(Basel), 10, pp.851~ (2021)
- Ahmed SM, "Lower respiratory tract infections(LTRIs) : an insight into the prevalence and the antibiogram of the Gram negative, respiratory, bacterial agents", J Clin Diagn Res, 7, pp.253~256 (2013)
- Shah SN, "Prevalence and susceptibility patterns of bacteria causing respiratory tract infections in North Waziristan, Pakistan", Pak J Pharm Sci, 29(Suppl 2), pp.701~706 (2016)
- Falagas ME, "Sex differences in the incidence and severity of respiratory tract infections", Respir Med, 101, pp.1845~1863 (2007)
- Sader HS, "Frequency of occurrence and antimicrobial susceptibility of bacteria isolated from respiratory samples of patients hospitalized with pneumonia in Western Europe, Eastern Europe and the USA : results from the SENTRY Antimicrobial Surveillance Program(2016-19)", JAC Antimicrob Resist, 3, pp.dlab117~ (2021)
- Arab O, "Resistance patterns of bacterial pathogens causing lower respiratory tract infections : Aleppo-Syria", Ann Med Surg(Lond), 85, pp.2655~2661 (2023)
- Xia W, "Changing trend of antimicrobial resistance among pathogens isolated from lower respiratory tract at a university-affiliated hospital of China, 2006-2010", J Thorac Dis, 4, pp.284~291 (2012)
- He R, "Differences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU", J Thorac Dis, 6, pp.1403~1410 (2014)
- Duan N, "Microbial distribution and antibiotic susceptibility of lower respiratory tract infections patients from pediatric ward, adult respiratory ward, and respiratory intensive care unit", Front Microbiol, 11, pp.1480~ (2020)
- Chai S, "Distribution patterns of pathogens causing lower respiratory tract infection based on metagenomic next-generation sequencing", Infect Drug Resist, 16, pp.6635~6645 (2023)
- Kritsotakis EI, "A systematic review of the global seasonality of infections caused by Acinetobacter species in hospitalized patients", Clin Microbiol Infect, 26, pp.553~562 (2020)
- "Antimicrobial resistance in the EU/EEA (EARS-Net) - Annual epidemiological report for 2022"[URL]
- Galani I, "In vitro activities of omadacycline, eravacycline, cefiderocol, apramycin, and comparator antibiotics against Acinetobacter baumannii causing bloodstream infections in Greece, 2020-2021 : a multicenter study", Eur J Clin Microbiol Infect Dis, 42, pp.843~852 (2023)
- Kyriakidis I, "Acinetobacter baumannii antibiotic resistance mechanisms", Pathogens, 10, pp.373~ (2021)
- Lynch JP 3rd, "Infections due to Acinetobacter baumannii in the ICU : treatment options", Semin Respir Crit Care Med, 38, pp.311~325 (2017)
- Inchai J, "Prognostic factors associated with mortality of drug-resistant Acinetobacter baumannii ventilator-associated pneumonia", J Intensive Care, 3, pp.9~ (2015)
- Jones RN, "Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia", Clin Infect Dis, 51(Suppl 1), pp.S81~S87 (2010)
- Maraki S, "Susceptibility of 2, 252 Pseudomonas aeruginosa clinical isolates over 4 years to 9 antimicrobials in a tertiary Greek hospital", Chemotherapy, 60, pp.334~341 (2014)
- Piperaki ET, "Klebsiella pneumoniae : virulence, biofilm and antimicrobial resistance", Pediatr Infect Dis J, 36, pp.1002~1005 (2017)
- "Carbapenem-and/or colistin-resistant Klebsiella pneumoniae in Greece: molecular follow-up survey 2022"[URL]
- Haque NZ, "Analysis of pathogen and host factors related to clinical outcomes in patients with hospital-acquired pneumonia due to methicillin-resistant Staphylococcus aureus", J Clin Microbiol, 50, pp.1640~1644 (2012)
- Souli M, "Nationwide surveillance of resistance rates of Staphylococcus aureus clinical isolates from Greek hospitals, 2012-2013", Infect Dis(Lond), 48, pp.287~292 (2016)
- Karakonstantis S, "The clinical significance of concomitant bacteriuria in patients with Staphylococcus aureus bacteremia. A review and meta-analysis", Infect Dis(Lond), 50, pp.648~659 (2018)