Abstract
Antibiotic resistance represents a major global concern. The rapid spread of opportunistically pathogenic carbapenemase-encoding bacteria (CEB) requires clinicians, researchers, and policy-makers to swiftly find solutions to reduce transmission rates and the associated health burden. Epidemiological data is key to planning control measures. Our study aims to contribute by providing an analysis of 397 unique CEB isolates detected in a tertiary hospital in Germany. We propose new findings on demographic variables to support preventive sanitary precautions in routine clinical practice. Data on detected CEB was combined with patient’s demographic and clinical information for each isolate. Multiple regression techniques were applied to estimate the predictive quality of observed differences. Our findings confirm the role of age and gender in CEB colonization patterns and indicate a role for ethnicity and domicile. Also, carbapenemase-encoding A. baumannii was most frequently introduced to the hospital, while the risk of colonization with VIM-encoding P. aeruginosa rose with the length of hospital stay. P. aeruginosa remains an important complication of prolonged hospital stays. The strong link to hospital-wastewater may have implications for hospital-built environments. A. baumannii can be efficiently controlled from spreading at hospital admission. OXA-encoding CEB being harder to detect in routine screening, targeted preventive measures, such as culture media selective for carbapenem-resistant bacteria, would be opportune for patients from selected regions. The CEB differences linked to ethnicity found in our study may further be supporting the tailoring of diagnostic approaches, as well as health policies upon confirmation by other studies and a better understanding of their global distribution.
Highlights
Bacteria excel at swiftly acquiring the genetic resources to thrive in environments that intend to inhibit their growth
Assuming that there is no gender imbalance regarding the overall amount of specimens received by our diagnostic unit, male patients (69.72%; 221/317) were more than twice as likely to be colonized with clinically relevant carbapenemase-encoding bacteria (CEB) compared to female patients (30.28%; 96/317)
As in other studies on multidrug-resistant gram-negative bacteria (GNB) (Kaase et al, 2016; Nicolas-Chanoine et al, 2019), in our study male patients were more prominently colonized with CEB
Summary
Bacteria excel at swiftly acquiring the genetic resources to thrive in environments that intend to inhibit their growth. Increasing anti-microbial resistance (AMR) continues to limit treatment options to where there may be no more cure. This growing threat to human health is a serious global concern with a significant health-economic burden. The most relevant carbapenemases include KPC, NDM, IMP, VIM, and OXA family enzymes, often carried on plasmids. Bacteria producing these enzymes are normally resistant to carbapenems but to most antibiotics, often due to additional resistance genes carried on those plasmids (Johnning et al, 2018; Sawa et al, 2020). Previous studies have shown an overall rise of the prevalence of CEB in Europe and have highlighted the need for enhanced containment efforts at both country and European levels (Albiger et al, 2015; David et al, 2019)
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