A pandemic within a pandemic? Admission to COVID-19 wards in hospitals is associated with increased prevalence of antimicrobial resistance in two African settings.

Autor: Elton L; Centre for Clinical Microbiology, University College London, London, UK. linzy.elton@ucl.ac.uk., Abdel Hamid MM; Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan., Tembo J; HerpeZ, University Teaching Hospital, Lusaka, Zambia., Elbadawi H; Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan.; MRC Clinical Trials Unit, University College London, London, UK., Maluzi K; HerpeZ, University Teaching Hospital, Lusaka, Zambia., Abdelraheem MH; Institute for Endemic Diseases, University of Khartoum, Khartoum, Sudan.; Sudan Atomic Energy Commission, Nuclear Application in Biological Sciences, Khartoum, Sudan., Cullip T; Institute for Global Health, University College London, London, UK., Kabanda C; HerpeZ, University Teaching Hospital, Lusaka, Zambia., Roulston K; Centre for Clinical Microbiology, University College London, London, UK., Honeyborne I; Centre for Clinical Microbiology, University College London, London, UK., Thomason MJ; Centre for Clinical Microbiology, University College London, London, UK.; MRC Clinical Trials Unit, University College London, London, UK., Elhag K; Soba University Hospital, University of Khartoum, Khartoum, Sudan., Mohammed A; Soba University Hospital, University of Khartoum, Khartoum, Sudan., Adam A; Soba University Hospital, University of Khartoum, Khartoum, Sudan., Mulonga K; HerpeZ, University Teaching Hospital, Lusaka, Zambia., Sikakena K; University Teaching Hospitals, Department of Internal Medicine, Infectious Diseases Unit, Lusaka, Zambia., Matibula P; University Teaching Hospitals, Department of Internal Medicine, Infectious Diseases Unit, Lusaka, Zambia., Kabaso M; University Teaching Hospitals, Department of Internal Medicine, Infectious Diseases Unit, Lusaka, Zambia., Nakazwe R; University Teaching Hospitals, Department of Internal Medicine, Infectious Diseases Unit, Lusaka, Zambia., Fwoloshi S; University Teaching Hospitals, Department of Internal Medicine, Infectious Diseases Unit, Lusaka, Zambia., Zumla A; Centre for Clinical Microbiology, University College London, London, UK.; National Institute for Health and Care Research Biomedical Research Centre, University College London, London, UK., McHugh TD; Centre for Clinical Microbiology, University College London, London, UK.
Jazyk: angličtina
Zdroj: Annals of clinical microbiology and antimicrobials [Ann Clin Microbiol Antimicrob] 2023 Apr 13; Vol. 22 (1), pp. 25. Date of Electronic Publication: 2023 Apr 13.
DOI: 10.1186/s12941-023-00575-1
Abstrakt: Background: Patients who develop severe illness due to COVID-19 are more likely to be admitted to hospital and acquire bacterial co-infections, therefore the WHO recommends empiric treatment with antibiotics. Few reports have addressed the impact of COVID-19 management on emergence of nosocomial antimicrobial resistance (AMR) in resource constrained settings. This study aimed to ascertain whether being admitted to a COVID-19 ward (with COVID-19 infection) compared to a non-COVID-19 ward (as a COVID-19 negative patient) was associated with a change in the prevalence of bacterial hospital acquired infection (HAI) species or resistance patterns, and whether there were differences in antimicrobial stewardship (AMS) and infection prevention and control (IPC) guidelines between COVID-19 and non-COVID-19 wards. The study was conducted in Sudan and Zambia, two resource constrained settings with differing country-wide responses to COVID-19.
Methods: Patients suspected of having hospital acquired infections were recruited from COVID-19 wards and non-COVID-19 wards. Bacteria were isolated from clinical samples using culture and molecular methods and species identified. Phenotypic and genotypic resistance patterns were determined by antibiotic disc diffusion and whole genome sequencing. Infection prevention and control guidelines were analysed for COVID-19 and non-COVID-19 wards to identify potential differences.
Results: 109 and 66 isolates were collected from Sudan and Zambia respectively. Phenotypic testing revealed significantly more multi-drug resistant isolates on COVID-19 wards in both countries (Sudan p = 0.0087, Zambia p = 0.0154). The total number of patients with hospital acquired infections (both susceptible and resistant) increased significantly on COVID-19 wards in Sudan, but the opposite was observed in Zambia (both p = ≤ 0.0001). Genotypic analysis showed significantly more β-lactam genes per isolate on COVID-19 wards (Sudan p = 0.0192, Zambia p = ≤ 0.0001).
Conclusions: Changes in hospital acquired infections and AMR patterns were seen in COVID-19 patients on COVID-19 wards compared to COVID-19 negative patients on non-COVID-19 wards in Sudan and Zambia. These are likely due to a potentially complex combination of causes, including patient factors, but differing emphases on infection prevention and control, and antimicrobial stewardship policies on COVID-19 wards were highlighted.
(© 2023. The Author(s).)
Databáze: MEDLINE
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