Impact of the COVID-19 pandemic on extended-spectrum β-lactamase producing Escherichia coli in urinary tract and blood stream infections: results from a nationwide surveillance network, Finland, 2018 to 2022.

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Heikki Ilmavirta, Jukka Ollgren, Kati Räisänen, Tuure Kinnunen, Antti Juhani Hakanen, Kaisu Rantakokko-Jalava, Jari Jalava, Outi Lyytikäinen
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Abstract

Background: Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum β-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen.

Methods: Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex.

Results: The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years.

Conclusions: The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.

COVID-19大流行对尿路和血流感染中产广谱β-内酰胺酶大肠埃希菌的影响:2018年至2022年芬兰全国监测网络的结果。
背景:在 COVID-19 大流行之前,大肠埃希菌的抗菌药耐药性(AMR)一直在持续上升,而大肠埃希菌是导致尿路感染和血液感染的最常见原因。本研究旨在调查 COVID-19 大流行对芬兰尿液和血液大肠杆菌分离物中广谱 β-内酰胺酶(ESBL)产生的影响,以加深我们对这一主要耐多药病原体来源的了解:方法:从芬兰临床微生物实验室的全国监测数据库中获取了564,233例尿液(88.3%来自女性)和23,860例血液(58.8%来自女性)大肠杆菌分离物的药敏试验结果。药敏试验是根据欧盟微生物检验委员会(EUCAST)指南进行的。我们比较了大流行之前(2018-2019年)、期间(2020-2021年)和之后(2022年)产ESBL大肠杆菌的比例和发病率,并按年龄组和性别进行了分层:结果:2018-2022年期间,每年进行抗菌药敏感性检测的尿液大肠杆菌分离物数量减少了23.3%,而血液大肠杆菌分离物数量增加了1.1%。尿液大肠杆菌分离物中产ESBL大肠杆菌的年比例在男性中下降了28.7%,从6.9%(2018-2019年期间的平均值)下降到2022年的4.9%,在女性中下降了28.7%,从3.0%下降到2.1%。在血液大肠杆菌分离物中,男性比例从9.3%降至6.2%,下降了32.9%;女性比例从6.2%降至4.6%,下降了26.6%。在大多数年龄组中也观察到了明显的下降趋势,但在年龄≥60岁的人群中风险仍然最高:结论:产ESBL大肠杆菌比例的下降是全面的,涵盖了两种标本类型、两种性别和所有年龄组,表明持续上升的趋势是可以逆转的。国际旅行和抗菌药物使用量的减少可能是导致这种现象减少的原因,这表明让旅行者了解耐多药细菌的风险、卫生措施和抗菌药物的适当使用对于预防至关重要。对医疗机构的感染控制措施进行评估可能会有所裨益,尤其是在长期护理中。
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来源期刊
Antimicrobial Resistance and Infection Control
Antimicrobial Resistance and Infection Control PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES
CiteScore
9.70
自引率
3.60%
发文量
140
审稿时长
13 weeks
期刊介绍: Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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