Abstract
Routine surveillance data revealed increasing rates of invasive extended-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCR-KP) in Switzerland, from 1.3% in 2004 to 8.5% in 2019. The main aim of this study was to understand the causes of this recent trend, specifically to identify predictors affecting the incidence of invasive ESCR-KP infections in Switzerland. A retrospective observational multi-centre study was conducted in 21 Swiss hospitals over a period of 11 years (2009-2019). Potential predictor variables for the incidence of invasive ESCR-KP infections were studied with a multiple linear regression model. In an additional analysis, the overall ESCR-KP incidence (all sample sites) was investigated. An increasing incidence of invasive ESCR-KP infections from 0.01 to 0.04 patients per 1000 bed-days was observed between 2009 and 2019 and confirmed by multiple linear regression analysis (P < 0.01). ESCR-KP incidence was higher in university hospitals (P < 0.01) and in the French-speaking region than in the German-speaking region (P < 0.01). There was no association with antibiotic consumption. Analysing the overall ESCR-KP incidence (all sample sites) revealed high variability between university hospitals, mainly due to a high proportion of patients with screening isolates at Geneva University Hospital (50% of patients with ESCR-KP). The incidence of invasive ESCR-KP infections increased in Switzerland between 2009 and 2019 and was not associated with antibiotic consumption. Our findings indicate that, in this low-incidence setting, structural factors such as the hospital type and the linguistic region play a more important role in relation to ESCR-KP incidence than the hospital's antibiotic consumption.
Highlights
Extended-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCR-KP) is a severe threat for hospitalized patients worldwide, causing bloodstream, intra-abdominal and urinary tract infections as well as severe pneumonia.In 2017, extended-spectrum b-lactamase (ESBL)-producingEnterobacterales were listed as one of the highest-priority pathogens for the research and development of new antibiotics by the World Health Organization [1]
The percentage of invasive K. pneumoniae isolates with resistance to third-generation cephalosporins increased in the European Union (EU) and Economic Area (EEA) from 21.5% to 31.7% (2009e2019) [4e6]
Routine surveillance data in Switzerland revealed an increase in the percentage of extended-spectrum cephalosporin resistance in invasive K. pneumoniae isolates from 4% to 8.5% (2009e2019) [7]
Summary
Extended-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCR-KP) is a severe threat for hospitalized patients worldwide, causing bloodstream, intra-abdominal and urinary tract infections as well as severe pneumonia.In 2017, extended-spectrum b-lactamase (ESBL)-producingEnterobacterales were listed as one of the highest-priority pathogens for the research and development of new antibiotics by the World Health Organization [1]. The percentage of invasive K. pneumoniae isolates with resistance to third-generation cephalosporins increased in the EU and EEA from 21.5% to 31.7% (2009e2019) [4e6]. Routine surveillance data in Switzerland revealed an increase in the percentage of extended-spectrum cephalosporin resistance in invasive K. pneumoniae isolates from 4% to 8.5% (2009e2019) [7]. Further risk factors described in the literature are prior use of fluoroquinolones, aminoglycosides, and trimethoprim/sulfamethoxazole since extended-spectrum cephalosporin resistance frequently accompanies cross-resistance to these antibiotics [9,13e15]. To date, it has not been investigated whether these factors are relevant in Switzerland, representing a low-incidence setting
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