Antibiotic Resistance Surveillance System Research Articles

Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017-2022.

Vancomycin-variable enterococci (VVE), though genetically containing van genes, are phenotypically sensitive to vancomycin. If VVE is undetected or does not grow on the vancomycin-resistant enterococci (VRE) selection medium, or both, it can acquire resistance upon exposure to vancomycin. This characteristic is clinically important for the treatment and prevention of VRE. This study aims to analyze the prevalence and characteristics of VVE in Korea through the Global Antibiotic Resistance Surveillance System (Kor-GLASS) and emphasize the importance of VVE. A total of 3342 enterococcal bloodstream isolates were collected through the Kor-GLASS between 2017 and 2022. Antibiotic susceptibility testing, van gene detection, and multilocus sequence typing were conducted with all the isolates. The trends in the domestic prevalence of VVE were analyzed and compared with global prevalence data. Among the isolates, 197 (5.9%), including 124 Enterococcus faecium and 73 E. faecalis, were identified as VVE. While the VRE incidence has declined in Korea since 2020, the VVE incidence is significantly rising. In Korea, only the vanA gene has been detected in both VRE and VVE, and no other van gene variants have been identified. Most of these isolates belong to CC17 (91.3%), with ST17, ST817, and ST80 as the predominant types. We have shown that continuous surveillance is essential in Korea due to the persistently high prevalence of VRE and the potential evolution of VVE into VRE. Consequently, it is critical to evaluate Enterococcus species isolated from domestic clinical settings for their phenotypic vancomycin resistance and the molecular detection of van genes, irrespective of the strain.

Repurposing antibiotic resistance surveillance data to support treatment of recurrent infections in a remote setting

In northern Australia, a region with limited access to healthcare and a substantial population living remotely, antibiotic resistance adds to the complexity of treating infections. Focussing on Escherichia coli urinary tract infections (UTIs) and Staphylococcus aureus skin & soft tissue infections (SSTIs) captured by a northern Australian antibiotic resistance surveillance system, we used logistic regression to investigate predictors of a subsequent resistant isolate during the same infection episode. We also investigated predictors of recurrent infection. Our analysis included 98,651 E. coli isolates and 121,755 S. aureus isolates from 70,851 patients between January 2007 and June 2020. Following an initially susceptible E. coli UTI, subsequent recovery of a cefazolin (8%) or ampicillin (13%) -resistant isolate during the same infection episode was more common than a ceftriaxone-resistant isolate (2%). For an initially susceptible S. aureus SSTI, subsequent recovery of a methicillin-resistant isolate (8%) was more common than a trimethoprim-sulfamethoxazole-resistant isolate (2%). For UTIs and SSTIs, prior infection with a resistant pathogen was a strong predictor of both recurrent infection and resistance in future infection episodes. This multi-centre study demonstrates an association between antibiotic resistance and an increased likelihood of recurrent infection. Particularly in remote areas, a patient’s past antibiograms should guide current treatment choices since recurrent infection will most likely be at least as resistant as previous infection episodes. Using population-level surveillance data in this way can also help clinicians decide if they should switch antibiotics for patients with ongoing symptoms, while waiting for diagnostic results.

A Clinical-Based Study to Evaluate the Extent of Microbial Sensitivity Tests Performed Among ICU Patients Prescribed with Antibiotics in a Tertiary Care Hospital

Antibiotic resistance is recognized as a global threat to human health. ICUs are generally considered as the main source of outbreaks of multi-drug resistant bacteria. Infectious complications are one of the dominant causes of morbidity and mortality among elderly and geriatric patients, especially in the ICU. The impact of microbial resistance on them is more due to immune senescence. This can be overcome by strengthening antibiotic resistance monitoring and surveillance systems. Antibacterial sensitivity analysis prior to antibiotic therapy is one of the tools in practicing rationality of antibiotic use as it helps to choose the most effective antibiotic. This study evaluates the extent of microbial sensitivity tests performed among ICU patients prescribed with antibiotics. A prospective observational study was conducted on a total of 60 ICU patients at Srinivas Institute of Medical Science and Research Centre, Mangalore, for a period of six months. ICU patients diagnosed with infectious diseases and prescribed with antibiotics are included in the study. Data were collected using an antimicrobial stewardship form and were analyzed using MS Excel 2016. Majority of the 60 people involved in the study were adults (36-65 yrs old) and geriatrics (65 yrs and older). Sensitivity test of pathogen toward various antibiotics were performed among 68.33% (N=41) of the patients, where most of the patients were Geriatrics(25%) and Adults(38.3%). Although the sensitivity test was performed on the majority of the patients in the study, it is critical to follow this test with antimicrobial therapy in each patient. It is important to evaluate the sensitivity of pathogen before therapy and at ongoing times of therapy which avoids complications due to resistance issues by enabling the selection of appropriate antimicrobial treatment and helps in overall clinical management. Keywords: Resistance, Sensitivity, Antibiotic, Geriatrics, ICU.

Utilization Of Antibiotics In Rural Communities Of Sub- Saharan Africa: Challenges And Resistances

In the last seven decades, antibiotics have greatly influenced the remarkable advancement in world health by becoming the standard therapy for infectious diseases. Antibiotic resistance (ABR) is a significant worldwide human health issue, having notably negative effects in low- and middle-income countries (LMICs). What were once fatal illnesses are now beaten by millions of people. But since there are only so many antibiotics available, misusing them has resulted in antibiotic resistance and decreased efficacy within a few years after the release of every lifesaving antibiotic. The WHO claims that the threat of antibiotic resistance to global health and development. The Sustainable Development Goals (SDGs) must be attained urgently through multi-sectoral approach. One of the ten leading worldwide public health hazards to civilization, according to WHO, is ABR. The major causes of the emergence of infections that are resistant to antibiotics are their improper usage and excessive use. The spread of bacteria, some of which may be antibiotic-resistant, is encouraged by a lack of safe drinking water, sanitation facilities, and effective infection control and prevention measures. Antibiotic resistance is as significant a threat to international security, food and nutrition security, and industrialization, according to the WHO, as terrorist attacks and global warming. ABR has a huge cost to the economy. Long-term disease not only increases the risk of mortality and incapacity but also lengthens hospital stay, necessitates the use of more expensive medications, and puts a strain on the finances of those affected. In the absence of powerful antibiotics, contemporary medicine's ability to cure infections, including those that arise following extensive surgeries and invasive procedures, would be compromised. Due to the lack of adequate mass surveillance, it is difficult to determine the scope of the ABR issue in LMICs, although considerable progress has been made in recent years since the WHO Global Antibiotic Resistance and Use Surveillance System (GLASS) initiative was launched in 2015. One of the main factors influencing the choice of ABR in LMICs is the widespread and frequently improper use of antibiotics in people, animals, and crops. This, combined with the insufficient control of pharmacological byproducts at the centers of manufacturing, must be quickly addressed. ABR spreads more quickly in LMICs because a number of factors including poor sanitation and hygiene insufficient exposure to sufficient health facilities, and a lack of legislation. The aim is to review to predisposing factors that influence the use of antibiotics aimed at informing policy decision on antibiotics use.

Germany's Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant Enterococcus faecium between 2015-2020.

In Germany, there is an increasing amount of vancomycin-resistant Enterococcus faecium (VREfm) isolates in bloodstream infections (BSIs); however, estimates on recent incidences and disease burden are missing. We aim to estimate the incidence and calculate the annual disease burden in disease-adjusted life years (DALYs) for BSIs due to VREfm in Germany between 2015 and 2020 to support informed decision-making in the field of antimicrobial resistance (AMR). We used the Antibiotic Resistance Surveillance (ARS) system data to obtain incidence estimates. The estimated incidences were used in the Burden of Communicable Disease in Europe (BCoDE) toolkit to calculate the attributable DALYs. A total of 3417 VREfm blood culture-positive isolates were observed within ARS. The estimated incidence of VREfm-BSIs per 100,000 inhabitants increased from 1.4 (95% Uncertainty Interval [UI]: 0.8-1.9) in 2015 to 2.9 (95% UI: 2.4-3.3) in 2020. The estimated burden, expressed in DALYs per 100,000 inhabitants, increased from 8.5 (95% UI: 7.3-9.7; YLD = 0.9, YLL = 7.6) in 2015 to 15.6 (95% UI: 14.6-16.6; YLD = 1.6, YLL = 14) in 2020. The most affected groups within the observed period are the 65-69-year-old males with 262.9 DALYs per 100,000 inhabitants, and in the younger age groups (<30 years), the under-one-year-old with 43.1 DALYs per 100,000 inhabitants and 34.5 DALYs for male and female, respectively. The increasing DALYs of BSIs due to VREfm require targeted prevention and control measures to address their unequal distribution across gender and age, especially for older hospitalized patients, neonates, and infants in Germany.

Experience in implementing the AMRcloud online platform for local antimicrobial resistance surveillance in a tertiary care hospital

Objective. To create local antibiotic resistance surveillance system using the AMRcloud online platform to provide evidence base for activity of antimicrobials (AM) and antimicrobial resistance (AMR) epidemiology. Materials and Methods. This study was conducted at the Pirogov National Medical and Surgical Center (Moscow, Russia). The study is prospective, with two evaluations of the local AMR surveillance system (before and after the implementation of the AMRcloud online platform). Separately, the effects of implementing the AMRcloud platform were evaluated and the most frequent scenarios of using this system in hospital were studied. Results. With the help of the AMRcloud platform, which acts as one of the central links in the AMR surveillance process, a local AMR surveillance system was formed, providing continuity of historical data and evidence base on local AMR epidemiology with real-time access and bringing together specialists of various profiles. Conclusions. Implementation of the AMRcloud online platform into multidisciplinary hospital operations enables the creation of a local evidence base on AM activity and AMR epidemiology, as well as reducing the labor costs of several crucial stages of AMR surveillance – data storage, analysis and exchange.

Trends of the Epidemiology of Candidemia in Switzerland: A 15-Year FUNGINOS Survey.

BackgroundThe increasing incidence of candidemia and emergence of drug-resistant Candida species are major concerns worldwide. Long-term surveillance studies are needed.MethodsThe Fungal Infection Network of Switzerland (FUNGINOS) conducted a 15-year (2004–2018), nationwide, epidemiological study of candidemia. Hospital-based incidence of candidemia, Candida species distribution, antifungal susceptibility, and consumption were stratified in 3 periods (2004–2008, 2009–2013, 2014–2018). Population-based incidence over the period 2009–2018 derived from the Swiss Antibiotic Resistance Surveillance System (ANRESIS).ResultsA total of 2273 Candida blood isolates were studied. Population and hospital-based annual incidence of candidemia increased from 2.96 to 4.20/100 000 inhabitants (P = .022) and 0.86 to 0.99/10 000 patient-days (P = .124), respectively. The proportion of Candida albicans decreased significantly from 60% to 53% (P = .0023), whereas Candida glabrata increased from 18% to 27% (P < .0001). Other non-albicans Candida species remained stable. Candida glabrata bloodstream infections occurred predominantly in the age group 18–40 and above 65 years. A higher proportional increase of C glabrata was recorded in wards (18% to 29%, P < .0001) versus intensive care units (19% to 24%, P = .22). According to Clinical and Laboratory Standards Institute, nonsusceptibility to fluconazole in C albicans was observed in 1% of isolates, and anidulafungin and micafungin nonsusceptibility was observed in 2% of C albicans and C glabrata. Fluconazole consumption, the most frequently used antifungal, remained stable, whereas use of mold-active triazoles and echinocandins increased significantly in the last decade (P < .0001).ConclusionsOver the 15-year period, the incidence of candidemia increased. A species shift toward C glabrata was recently observed, concurring with increased consumption of mold-active triazoles.

Antibiotic resistance in uropathogens across northern Australia 2007-20 and impact on treatment guidelines.

BackgroundUrinary tract infections are common and are increasingly resistant to antibiotic therapy. Northern Australia is a sparsely populated region with limited access to healthcare, a relatively high burden of disease, a substantial regional and remote population, and high rates of antibiotic resistance in skin pathogens.ObjectivesTo explore trends in antibiotic resistance for common uropathogens Escherichia coli and Klebsiella pneumoniae in northern Australia, and how these relate to current treatment guidelines in the community and hospital settings.MethodsWe used data from an antibiotic resistance surveillance system. We calculated the monthly and yearly percentage of isolates that were resistant in each antibiotic class, by bacterium. We analysed resistance proportions geographically and temporally, stratifying by healthcare setting. Using simple linear regression, we investigated longitudinal trends in monthly resistance proportions and correlation between community and hospital isolates.ResultsOur analysis included 177 223 urinary isolates from four pathology providers between 2007 and 2020. Resistance to most studied antibiotics remained <20% (for E. coli and K. pneumoniae, respectively, in 2019: amoxicillin/clavulanate 16%, 5%; cefazolin 17%, 8%; nitrofurantoin 1%, 31%; trimethoprim 36%, 17%; gentamicin 7%, 2%; extended-spectrum cephalosporins 8%, 5%), but many are increasing by 1%–3% (absolute) per year. Patterns of resistance were similar between isolates from community and hospital patients.ConclusionsAntibiotic resistance in uropathogens is increasing in northern Australia, but treatment guidelines generally remain appropriate for empirical therapy of patients with suspected infection (except trimethoprim in some settings). Our findings demonstrate the importance of local surveillance data (HOTspots) to inform clinical decision making and guidelines.

Resistance Patterns from Urine Cultures in Children Aged 0 to 6 Years: Implications for Empirical Antibiotic Choice.

PurposeUrinary tract infection (UTI) is a frequent disorder of childhood, caused mainly by Gram negative Enterobacterales. The aim of this study is to evaluate etiology and antimicrobial susceptibility patterns of bacterial isolates in urine cultures of children under the age of 6 and to analyze the relationship between previous hospitalization or antibiotic prescriptions and antimicrobial resistance rates.Patients and MethodsA retrospective study on positive urine cultures from 13 public laboratories in Tuscany, Italy was conducted. Data were obtained by reviewing records of the “Microbiological and Antibiotic-Resistance Surveillance System” (SMART) in Tuscany, Italy. A total of 2944 positive urine cultures were collected from 2445 children.ResultsEscherichia coli represented the majority of isolates (54,2%), followed by Enterococcus faecalis (12,3%), Proteus mirabilis (10,3%) and Klebsiella pneumoniae (6,6%). Isolated uropathogens showed high resistance rates to amoxicillin-clavulanate (>25%), particularly in children under one year of age or hospitalized within the 12 months before the sample collection. High susceptibility rates were reported of aminoglycosides, cephalosporins and quinolones (>90%). Previous antibiotic prescriptions by general pediatricians did not increase resistance rates.ConclusionOur results show a rate of amoxicillin-clavulanate resistance of 25%. Higher resistance rates were reported in children under one year of age and with previous hospitalization. Hence, amoxicillin-clavulanate should be used carefully in young children and those with severe symptoms.

Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010–2018

Background The Nordic countries have comparable nationwide antibiotic resistance surveillance systems and individual antibiotic stewardship programmes. The aim of this study was to assess antibiotic resistance among major pathogens in relation to practice guidelines for hospital antibiotic treatment and antibiotic use in Nordic countries 2010–2018. Methods Antibiotic resistance among invasive isolates from 2010–2018 and aggregated antibiotic use were obtained from the European Centre for Disease Prevention and Control. Hospital practice guidelines were obtained from national or regional guidelines. Results Antibiotic resistance levels among Escherichia coli and Klebsiella pneumoniae were similar in all Nordic countries in 2018 and low compared to the European mean. Guidelines for acute pyelonephritis varied; 2nd generation cephalosporin (Finland), 3rd generation cephalosporins (Sweden, Norway), ampicillin with an aminoglycoside or aminoglycoside monotherapy (Denmark, Iceland and Norway). Corresponding guidelines for sepsis of unknown origin were 2nd (Finland) or 3rd (Sweden, Norway, Iceland) generation cephalosporins, carbapenems, (Sweden) combinations of penicillin with an aminoglycoside (Norway, Denmark), or piperacillin-tazobactam (all Nordic countries). Methicillin-resistant Staphylococcus aureus rates were 0–2% and empirical treatment with anti-MRSA antibiotics was not recommended in any country. Rates of penicillin non-susceptibility among Streptococcus pneumoniae were low (<10%) except in Finland and Iceland (<15%), but benzylpenicillin was recommended for community-acquired pneumonia in all countries. Conclusion Despite similar resistance rates among Enterobacteriaceae there were differences in practice guidelines for pyelonephritis and sepsis. National surveillance of antibiotic resistance can be used for comparison and optimization of guidelines and stewardship interventions to preserve the low levels of antibiotic resistance in Nordic countries.

From the Farms to the Dining Table: The Distribution and Molecular Characteristics of Antibiotic-Resistant Enterococcus spp. in Intensive Pig Farming in South Africa.

Foodborne pathogens, including antibiotic-resistant species, constitute a severe menace to food safety globally, especially food animals. Identifying points of concern that need immediate mitigation measures to prevent these bacteria from reaching households requires a broad understanding of these pathogens’ spread along the food production chain. We investigated the distribution, antibiotic susceptibility, molecular characterization and clonality of Enterococcus spp. in an intensive pig production continuum in South Africa, using the farm-to-fork approach. Enterococcus spp. were isolated from 452 samples obtained along the pig farm-to-fork continuum (farm, transport, abattoir, and retail meat) using the IDEXX Enterolert®/Quanti-Tray® 2000 system. Pure colonies were obtained on selective media and confirmed by real-time PCR, targeting genus- and species-specific genes. The susceptibility to antibiotics was determined by the Kirby–Bauer disk diffusion method against 16 antibiotics recommended by the WHO-AGISAR using EUCAST guidelines. Selected antibiotic resistance and virulence genes were detected by real-time PCR. Clonal relatedness between isolates across the continuum was evaluated by REP-PCR. A total of 284 isolates, consisting of 79.2% E. faecalis, 6.7% E. faecium, 2.5% E. casseliflavus, 0.4% E. gallinarum, and 11.2% other Enterococcus spp., were collected along the farm-to-fork continuum. The isolates were most resistant to sulfamethoxazole-trimethoprim (78.8%) and least resistant to levofloxacin (5.6%). No resistance was observed to vancomycin, teicoplanin, tigecycline and linezolid. E. faecium displayed 44.4% resistance to quinupristin-dalfopristin. Also, 78% of the isolates were multidrug-resistant. Phenotypic resistance to tetracycline, aminoglycosides, and macrolides was corroborated by the presence of the tetM, aph(3′)-IIIa, and ermB genes in 99.1%, 96.1%, and 88.3% of the isolates, respectively. The most detected virulence gene was gelE. Clonality revealed that E. faecalis isolates belonged to diverse clones along the continuum with major REP-types, mainly isolates from the same sampling source but different sampling rounds (on the farm). E. faecium isolates revealed a less diverse profile. The results suggest that intensive pig farming could serve as a reservoir of antibiotic-resistant bacteria that could be transmitted to occupationally exposed workers via direct contact with animals or consumers through animal products/food. This highlights the need for more robust guidelines for antibiotic use in intensive farming practices and the necessity of including Enterococcus spp. as an indicator in antibiotic resistance surveillance systems in food animals.

Human bile microbiota: A retrospective study focusing on age and gender

AimsThe emerging biliary colonization of microorganisms in patients with biliary diseases may be devastating. Recent evidence suggests that age and gender may influence changes in the microbial composition of gut microbiota. To study the relationship between these parameters on bile microbiota, we retrospectively reviewed positive bile cultures following an endoscopic retrograde cholangiopancreatography (ERCP) in a QA-certified academic surgical unit of a single institution. Methods449 positive bile cultures from 172 Italian patients with diseases of the biliopancreatic system hospitalized from 2006 through 2017 were investigated for aerobic, anaerobic, and fungal organisms. The patients were stratified into four age intervals (22−66, 67−74, 75−81, and 82−93 years) and followed up for five years. ResultsGram-positive bacteria (GPB) was negatively associated with age only in multivariate analysis (Rpartial = −0.114, p = 0.017), with younger patients prone to harbor GPB and older patients likely to have Gram-negative bacteria (GNB). There was a definite link with the male gender using both univariate and multivariate analysis (p < 0.001). Enterococcus spp. was the most common strain identified in patients with GPB except for patients aged 67−74 years for male (95.2%) and female (80.9%) patients. Escherichia coli and Klebsiella spp. were most frequent than others in every group analyzed. Analogous results were found for bacteria Non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas spp. and Stenotrophomonas spp. apart of the 2nd quartile. ConclusionsOur study strengthens the bond of age and gender with bile microbiota composition and suggests that further investigations may be required in targeting the aging microbiome. Other studies should also focus on Mediterranean epidemiological characteristics and antibiotic resistance surveillance system strategies

AMRmap – antibiotic resistance surveillance system in Russia

Objective. To review the basic principles and functionality of the AMRmap online resource. Materials and Methods. The AMRmap platform was developed using the R programming language and various downloadable modules – packages. The current annually updated version of EUCAST clinical breakpoints was applied for determination of categories of susceptibility to antimicrobial agents. Descriptive analysis includes calculation of absolute and relative frequencies, median values, and confidence intervals using the Wilson method. Categorical variables are compared using Fisher’s exact test and Holm correction method for multiple comparisons. The algorithms are used to visualize multiple comparisons, kernel regression for trend analysis, and algorithms for finding associative rules. Results. The developed surveillance system includes modules for filtering, analyzing and visualizing antibiotic resistance data. The filters allow creating a sample of data with a specific list of parameters. A tab-based separation of analysis and visualization options ensure efficient stepwise evaluation of results. Data saving and sharing functions are also provided. Conclusions. This web-based informatics system provides a convenient way to AMR data from prospective microbiological surveillance studies in Russia. AMRmap can be accessed at https://amrmap.ru.

Extending the Use of Healthcare-Associated Infections and Antibiotic Use and Resistance Surveillance Data

Background: The CDC National Healthcare Safety Network (NHSN) is the nation’s most widely used healthcare-associated infection (HAI) and antibiotic use and resistance (AUR) surveillance system. More than 22,000 healthcare facilities report data to the NHSN. The NHSN data are used by facilities, the CDC, health departments, the CMS, among other organizations and agencies. In 2017, the CDC updated the NHSN Agreement to Participate and Consent (Agreement), completed by facilities, broadening health department access to NHSN data and extending eligibility for data use agreements (DUAs) to local and territorial health departments. DUAs enable access to NHSN data reported by facilities in the health department’s jurisdiction and have been available to state health departments since 2011. The updated agreement also enables the CDC to provide NHSN data to health departments for targeted prevention projects outbreak investigations and responses. Methods: We reviewed the current NHSN DUA inventory to assess the extent to which health departments use the NHSN’s new data access provisions and used semistructured interviews with health department staff, conducted via emails, phone, and in person conversations, to identify and describe their NHSN data uses. Results: As of late 2019, the NHSN has DUAs with health departments in 17 states, 7 local health departments (including municipalities and counties), and 1 US territory. The NHSN also has received requests from 2 state health departments for data supporting HAI prevention projects. Health departments with DUAs described improved relationships with facilities in their jurisdictions because of new opportunities to offer NHSN data analysis assistance to facilities. One local health department analyzed their NHSN carbapenem-resistant Enterobacteriaceae (CRE) data to identify (1) facilities in its jurisdiction with comparatively high CRE infection burden and (2) geographic areas to target for a CRE isolate submission program. Outreach to facilities with high CRE burden led to enrollment of 15 clinical laboratories into a voluntary isolate submission program to analyze CRE isolates for additional characterization. Examples of health departments’ use of data for action include: notifying facilities with high standardized infection ratios (SIRs) and sharing Targeted Assessment for Prevention (TAP) reports. Conclusions: The NHSN’s role as a shared surveillance resource has expanded in multiple public health jurisdictions as a result of new data access provisions. Health departments are using NHSN data in their programmatic responses to HAI and AR challenges. New access to NHSN data is enabling public health jurisdictions to assess problems and opportunities, provide guidance for prevention projects, and support program evaluations.Funding: NoneDisclosures: None

Methodology and Early Results of the First Surveillance Program on Prevention and Control of Antimicrobial Resistance in Isfahan, Iran: The IAS-I Study.

Background:Isfahan Antibiotic Resistance Surveillance System-1 has been instituted in Isfahan, Iran to construct a project for surveillance of clinically significant bacteria, and to help raise a logic regional stewardship program for prevention and control of disseminating-resistant organisms.Methods:During March 2016 to March 2018, an antibiotic resistance surveillance system was designed and implemented by Isfahan Infectious Diseases and Tropical Medicine Research Center. The surveillance program was implemented in three general hospitals in Isfahan. In addition to the routine microbiology data, clinical data (differentiation between true infections and contamination, healthcare-associated infections (HCAI) and community-acquired infections (CAI), as well as determination of the infection site) were obtained and analyzed by WHONET software.Results:During a 2-year period, from 7056 samples that revealed growth of bacteria, 3632 (51.5%) isolates were detected as contamination and 3424 (48.5%) true bacterial isolates were identified. Of these, about 32% of isolates were recognized as HCAI. Totally, the most recognized infections were urinary tract infection, bloodstream infection and skin and soft tissue infections. In patients with HCAIs, 70% of isolates were gram negative and in patients with CAIs 73% isolates were gram negative bacteria.Conclusions:The strength of the project is gathering enough clinical information in addition to microbiologic data, which would increase application of the results for empiric treatment and prevention of the infectious diseases in clinical settings.

Vigilancia activa de la resistencia a antibióticos

The magnitude of the impact of antibiotic resistance (AR) is now well recognised. Implementation of measures for its control is essential, but for them to be efficacious and cost-effective, they must be guided by prior knowledge of the problem that is as up-to-date, real and complete as possible. However, the current scale of AR is difficult to quantify due to the wide heterogeneity of data collection, the existence of large gaps in surveillance capacity and its deficient coordination. Therefore, it is necessary to structure holistic, integrative and high-quality AR surveillance systems that allow the early analysis of combined data (micro-biological, clinical, epidemiological data) from different sources (humans, foods, animals and environment) to guide decision making for the control of AR. Some of the main characteristics that a structure of this scale should have are: a multidisciplinary consensus on protocols, criteria and techniques; the combination and coordination of different approaches seeking to fill possible gaps in surveillance; the deve lopment of a global antibiotic policy that allows and facilitates the existence of common, updated and accessible surveillance systems; the use of agile and compatible computer systems that allow a «real time» dump in common databases; and political involvement to include monitoring of AR in the political agenda and to commit the necessary resources. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016», which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A.© 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved.

Catheter-related infections: does the spectrum of microbial causes change over time? A nationwide surveillance study

ObjectivesTo estimate the incidence and epidemiology of catheter-related bloodstream infections (CRBSIs) on a national scale by using prospective epidemiological data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS).DesignObservational study.SettingNational surveillance...

Low incidence of subsequent bacteraemia or fungaemia after removal of a colonized intravascular catheter tip

ObjectivesWe determined the frequency of subsequent bloodstream infection more than 2 days after removal of a catheter with positive tip cultures. MethodsWe conducted a nationwide, observational study on intravascular catheter (IVC) tip cultures in Switzerland from 2008 to 2015 using data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). An IVC tip culture was included in the analysis if at least one microorganism could be cultivated from it. We excluded all data from patients with concurrent bacteraemia with the same microorganism identified 7 days before to 2 days after IVC removal. Subsequent bloodstream infection was defined as isolating (from blood cultures performed more than 2 days up to 7 days after catheter removal) the same microorganism as the one recovered from the IVC. Data on antibiotic therapy were not available in this surveillance study. ResultsOver the 8-year period, 15 033 positive IVC tip cultures were identified. Our study population comprised 12 513 episodes of positive IVC tip cultures without concurrent bacteraemia. The frequency of sBSI was 1.8% (n = 219). Subsequent bloodstream infections were more frequently detected after identification of C. albicans (10/113, 8.8%), S. marcescens (9/169, 5.3%), and S. aureus (30/623, 4.8%) on a catheter tip. ConclusionsA very low incidence of subsequent bloodstream infection was observed if a microorganism was identified on a removed IVC tip without concurrent bacteraemia. The risk of subsequent bloodstream infection increased if C. albicans, S. aureus, or S. marcescens were identified in this context.

Characterizing non-linear effects of hospitalisation duration on antimicrobial resistance in respiratory isolates: an analysis of a prospective nationwide surveillance system

ObjectivesOur objective was to systematically study the influence of length of hospital stay on bacterial resistance in relevant respiratory tract isolates. MethodsUsing prospective epidemiological data from the National Swiss Antibiotic Resistance Surveillance System, susceptibility testing results for respiratory isolates retrospectively retrieved from patients hospitalised between 2008 and 2014 were compiled. Generalized additive models were used to illustrate resistance rates relative to hospitalisation duration and to adjust for co-variables. ResultsIn all, 19 622 isolates of six relevant and predominant species were included. Resistance patterns for the predominant species showed a species-specific and antibiotic-resistance-specific profile in function of hospitalisation duration. The oxacillin resistance profile in Staphylococcus aureus isolates was constantly increasing (monophasic). The pattern of resistance to cefepime in Pseudomonas aeruginosa was biphasic with a decreasing resistance rate for the first 5 days of hospitalisation and an increase for days 6–30. A different biphasic pattern occurred in Escherichia coli regarding amoxicillin-clavulanic acid resistance: odds/day increased for the first 7 days of hospitalisation and then remained stable for days 8–30. In the adjusted models epidemiological characteristics such as age, ward type, hospital type and linguistic region were identified as relevant co-variables for the resistance rates. The contribution of these confounders was specific to the individual species/antibiotic resistance models. ConclusionsResistance rates do not follow a dichotomic pattern (early versus late nosocomial) as suggested by current hospital-acquired pneumonia treatment guidelines. Duration of hospitalisation rather appears to have a more complex and non-linear relationship with bacterial resistance in hospital-acquired pneumonia, also depending on host and environmental factors.

Incidence of bloodstream infections: a nationwide surveillance of acute care hospitals in Switzerland 2008–2014

BackgroundBloodstream infections are often associated with significant mortality and morbidity. We aimed to investigate changes in the epidemiology of bloodstream infections in Switzerland between 2008 and 2014.MethodsData on bloodstream infections...