Abstract
Introduction: We studied the trend of antimicrobial resistance and consumption at Saint George Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. Materials and Methods: We calculated the isolation density/1000 patient-days (PD) of the most isolated organisms from 1 January 2015–31 December 2020 that included: E. coli (Eco), K. pneumoniae (Kp), P. aeruginosa (Pae), A. baumannii (Ab), S. aureus (Sau), and E. faecium (Efm). We considered March–December 2020 a surrogate of COVID-19. We considered one culture/patient for each antimicrobial susceptibility and excluded Staphylococcus epidermidis, Staphylococcus coagulase-negative, and Corynebacterium species. We analyzed the trends of the overall isolates, the antimicrobial susceptibilities of blood isolates (BSI), difficult-to-treat (DTR) BSI, carbapenem-resistant Enterobacteriaceae (CRE) BSI, and restricted antimicrobial consumption as daily-defined-dose/1000 PD. DTR implies resistance to carbapenems, beta-lactams, fluoroquinolones, and additional antimicrobials where applicable. Results and Discussion: After applying exclusion criteria, we analyzed 1614 blood cultures out of 8314 cultures. We isolated 85 species, most commonly Eco, at 52%. The isolation density of total BSI in 2020 decreased by 16%: 82 patients were spared from bacteremia, with 13 being DTR. The isolation density of CRE BSI/1000 PD decreased by 64% from 2019 to 2020, while VREfm BSI decreased by 34%. There was a significant decrease of 80% in Ab isolates (p-value < 0.0001). During COVID-19, restricted antimicrobial consumption decreased to 175 DDD/1000 PD (p-value < 0.0001). Total carbapenem consumption persistently decreased by 71.2% from 108DDD/1000 PD in 2015–2019 to 31 DDD/1000 PD in 2020. At SGHUMC, existing epidemics were not worsened by the pandemic. We attribute this to our unique and dynamic collaboration of antimicrobial stewardship, infection prevention and control, and infectious disease consultation.
Highlights
We studied the trend of antimicrobial resistance and consumption at SaintGeorge Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic
Eighty-five different species were isolated (Supplementary Table S1), of which we studied the following organisms that were isolated more than 500 times in our laboratories: Escherichia coli (Eco), Klebsiella pneumonia (Kp), Pseudomonas aeruginosa (Pae), Acinetobacter baumannii (Ab), Staphylococcus aureus (Sau), and Enterococcus faecium (Efm)
We determined the various trends of isolation density of a total of 1614 unique bloodstream isolates and their antimicrobial susceptibilities and calculated the consumption of restricted antimicrobials
Summary
We studied the trend of antimicrobial resistance and consumption at SaintGeorge Hospital University Medical Center (SGHUMC), a tertiary care center in Beirut, Lebanon, with a focus on the SARS-CoV-2 pandemic. The SARS-CoV-2 pandemic has greatly marked our past year, and its burden may be reflected in the 3,770,361 deaths worldwide between March 2020 and 11 June 2021 [1] It revealed the devastating realities of healthcare systems worldwide, which mostly fell under the pressure of a massive influx of critically ill patients [2,3]. A higher number of critically ill patients, insufficient PPE, understaffed hospitals, prolonged hospitalizations, and longer durations of invasive mechanical intubation are all risk factors that may increase nosocomial infections [14,15,16,17,18] What makes this more concerning is the rising spread of antimicrobial resistance [19,20], especially since most the above-mentioned risk factors may favor harboring multi-drug resistance organisms [21], including last resort options such as carbapenem and colistin
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