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Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized...
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Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Virology".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 18548

Special Issue Editor

Prof. Dr. Antonella d'Arminio Monforte

E-Mail Website
Guest Editor
1. Icona Foundation, 20142 Milan, Italy
2. Clinic of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy
Interests: liver diseases; HIV infection; HIV prevention; tuberculosis; clinical infectious diseases; infectious disease epidemiology; mycobacterium tuberculosis; viral infection; immunology of infectious diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

During the ongoing COVID-19 pandemic, antibiotics have been extensively used for the management of hospitalized patients infected with SARS-CoV-2. Unintended consequences of antimicrobial overuse include, among others, the increment of bacterial resistance and the circulation of multidrug-resistant organisms (MDROs). On the other hand, the management of hospitalized SARS-CoV-2 patients increases the risk of outbreak due to MDROs for several reasons, including the increased number of patients, increased length of hospital stay, extensive antibiotic use, lack of infection prevention and control measures and interruption of antimicrobial stewardship programs.

In this Special Issue of Microorganisms we would like to review the latest knowledge about AMR rates and in-hospital outbreaks in the COVID-19 setting, with particular regard toward the infection prevention and control (IPC) strategies adopted and the antimicrobial stewardship programs implemented.

Dr. Antonella D'Arminio Monforte
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19
  • SARS-CoV-2
  • antimicrobial resistance
  • infection prevention and control
  • antimicrobial stewardship
  • outbreak
  • healthcare-associated infections

Published Papers (6 papers)

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Research

11 pages, 277 KiB  
Article
Incidence and Microbiology of Hospital-Acquired Infections in COVID-19 Patients between the First and the Second Outbreak of the SARS-CoV-2 Pandemic: A Retrospective, Observational Study
by Corti Nicolò, Tordato Federica, Guendalina De Nadai, Mapelli Sarah, Garlanda Cecilia, Pocaterra Daria, Casana Maddalena, Bonfanti Paolo and Morelli Paola
Microorganisms 2022, 10(12), 2372; https://doi.org/10.3390/microorganisms10122372 - 30 Nov 2022
Viewed by 1467
Abstract
With almost 638 million cases and over 6 million deaths worldwide, the SARS-CoV-2 pandemic represents an unprecedented healthcare challenge. Although the management and natural history of COVID-19 patients have changed after the introduction of active therapies and vaccination, the development of secondary infections [...] Read more.
With almost 638 million cases and over 6 million deaths worldwide, the SARS-CoV-2 pandemic represents an unprecedented healthcare challenge. Although the management and natural history of COVID-19 patients have changed after the introduction of active therapies and vaccination, the development of secondary infections complicates hospital stay. This is a single-center, retrospective, observational study that explores the incidence and microbiology of hospital-acquired infections (HAIs) in two subsequent populations of hospitalized patients with COVID-19. Demographic, pre-hospitalization baseline characteristics, therapeutic options and microbiology data about secondary infections were collected for a total of 1153 cases. The second population appeared to have a higher median age (73 vs. 63 years, respectively), comorbidities (median Charlson Comorbidity Index Score was 4 vs. 1, respectively) and incidence of secondary infections (23.5% vs. 8.2%) with respect to the first. A higher incidence of multi-drug resistant organisms (MDROs), including difficult-to-treat resistant (DTR) Pseudomonas, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), was also observed. Both patients’ characteristics and poor adherence to standard hygiene and infection control protocols may have contributed to the higher incidence of these events and may have impacted on the natural history of the disease. In-hospital mortality rates were similar, despite the introduction of active therapies against COVID-19 (24.7% vs. 23.5%, respectively). The incidence of HAIs may have contributed to the unchanged mortality and prompts for more effective antimicrobial stewardship and infection control procedures in COVID-19. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients)
14 pages, 1353 KiB  
Article
Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial
by Nikola Delić, Andrija Matetic, Josipa Domjanović, Toni Kljaković-Gašpić, Lenko Šarić, Darko Ilić, Svjetlana Došenović, Josipa Domazet, Ruben Kovač, Frane Runjić, Sanda Stojanović Stipić and Božidar Duplančić
Microorganisms 2022, 10(6), 1118; https://doi.org/10.3390/microorganisms10061118 - 28 May 2022
Cited by 5 | Viewed by 2850
Abstract
The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University [...] Read more.
The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University Hospital of Split between October 2020 and June 2021. Patients were randomized and allocated to a control group (no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, while secondary outcomes included all-cause mortality. Routine inhalation therapy had no effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). Secondary analyses revealed a significant reduction of Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) VAP in the treatment groups. Specifically, the bicarbonate group had a statistically significantly lower incidence of Gram-positive bacterial VAP (4.8%), followed by the N-acetylcysteine group (10.3%), 5% saline group (19.0%), and control group (34.6%; p = 0.001). This difference was driven by a lower incidence of MRSA VAP in the bicarbonate group (2.4%), followed by the N-acetylcysteine group (7.7%), 5% saline group (14.3%), and control group (34.6%; p < 0.001). Longer duration of ventilator therapy was the only significant, independent predictor of any bacterial or fungal VAP in the multivariate analysis (aOR 1.14, 95% CI 1.01–1.29, p = 0.038 and aOR 1.05, 95% CI 1.01–1.10, p = 0.028, respectively). In conclusion, inhalation therapy had no effect on the overall VAP incidence or all-cause mortality. Further studies should explore the secondary findings of this study such as the reduction of Gram-positive or MRSA-caused VAP in treated patients. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients)
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7 pages, 440 KiB  
Communication
Is the Pendulum of Antimicrobial Drug Resistance Swinging Back after COVID-19?
by Francesca Serapide, Angela Quirino, Vincenzo Scaglione, Helen Linda Morrone, Federico Longhini, Andrea Bruni, Eugenio Garofalo, Giovanni Matera, Nadia Marascio, Giuseppe Guido Maria Scarlata, Claudia Cicino, Alessandro Russo, Enrico Maria Trecarichi and Carlo Torti
Microorganisms 2022, 10(5), 957; https://doi.org/10.3390/microorganisms10050957 - 02 May 2022
Cited by 15 | Viewed by 1882
Abstract
The COVID-19 pandemic may have had an effect on antimicrobial resistance. We compared the prevalence of ESKAPE multidrug-resistant (MDR) bacterial infections in COVID-19 affected/unaffected patients admitted to intensive care units (ICU) or infectious disease units at the “Mater Domini” University Hospital of Catanzaro [...] Read more.
The COVID-19 pandemic may have had an effect on antimicrobial resistance. We compared the prevalence of ESKAPE multidrug-resistant (MDR) bacterial infections in COVID-19 affected/unaffected patients admitted to intensive care units (ICU) or infectious disease units at the “Mater Domini” University Hospital of Catanzaro between 1 March 2020 and 31 July 2021. Moreover, an analysis of MDR rates in ICU comparing the pre-pandemic period with the pandemic period was performed, and the possible consequence on in-hospital mortality was explored. One hundred and eighty-four ESKAPE isolates were analyzed from 362 SARS-CoV-2 positive and 199 negative patients. In total, 116 out of 171 Gram-negative isolates were classified as MDR, and a higher frequency was observed in COVID-19 compared with non-COVID-19 patients (74.2% vs. 60.3%; p = 0.052). A higher rate of MDR ESKAPE bacteria was observed in COVID-19 patients admitted to the ICU compared with COVID-19 unaffected patients admitted to the same ward in 2019 (88% vs. 80.4%; p = 0.186). Acinetobacter baumannii was the main pathogen in COVID-19 patients (58.7%), where it was the most frequent cause of bloodstream infection with the highest mortality rate (68.7%). Increase in MDR appeared to be associated with COVID-19 but only in the ICU setting. Acinetobacter baumannii was associated with the risk of death, indicating the importance of implementing infection control measures urgently. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients)
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13 pages, 1306 KiB  
Article
Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors
by Mariateresa Ceparano, Valentina Baccolini, Giuseppe Migliara, Claudia Isonne, Erika Renzi, Daniela Tufi, Corrado De Vito, Maria De Giusti, Maria Trancassini, Francesco Alessandri, Giancarlo Ceccarelli, Francesco Pugliese, Paolo Villari, Maria Angiulli, Stefania Battellito, Arianna Bellini, Andrea Bongiovanni, Lucilla Caivano, Marta Castellani, Monica Coletti, Alessia Cottarelli, Ludovica D’Agostino, Andrea De Giorgi, Chiara De Marchi, Irma Germani, Dara Giannini, Elisa Mazzeo, Shadi Orlandi, Matteo Piattoli, Eleonora Ricci, Leonardo Maria Siena, Alessandro Territo, Gianluca Vrenna, Stefano Zanni and Carolina Marzuilloadd Show full author list remove Hide full author list
Microorganisms 2022, 10(4), 722; https://doi.org/10.3390/microorganisms10040722 - 28 Mar 2022
Cited by 25 | Viewed by 2776
Abstract
Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. [...] Read more.
Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78–9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients)
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8 pages, 362 KiB  
Article
Outbreak of MRSA in a Gynecology/Obstetrics Department during the COVID-19 Pandemic: A Cautionary Tale
by Mareike Möllers, Marie-Kristin von Wahlde, Franziska Schuler, Alexander Mellmann, Christian Böing, Vera Schwierzeck, Julia Sophie Schneider and Stefanie Kampmeier
Microorganisms 2022, 10(4), 689; https://doi.org/10.3390/microorganisms10040689 - 23 Mar 2022
Cited by 6 | Viewed by 3381
Abstract
Since March 2020, the COVID-19 pandemic forced hospitals worldwide to intensify their infection control measures to prevent health care-associated transmission of SARS-CoV-2. The correct use of personal protective equipment, especially the application of masks, was quickly identified as priority to reduce transmission with [...] Read more.
Since March 2020, the COVID-19 pandemic forced hospitals worldwide to intensify their infection control measures to prevent health care-associated transmission of SARS-CoV-2. The correct use of personal protective equipment, especially the application of masks, was quickly identified as priority to reduce transmission with this pathogen. Here, we report a nosocomial cluster of methicillin-resistant Staphylococcus aureus (MRSA) that occurred during the COVID-19 pandemic in a gynecology/obstetrics department, despite these intensified contact precautions. Five MRSA originating from clinical samples after surgical intervention led to an outbreak investigation. Firstly, this included environmental sampling of the operation theatre (OT) and, secondly, a point prevalence screening of patients and health care workers (HCW). All detected MRSA were subjected to whole genome sequencing (WGS) and isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). WGS revealed one MRSA cluster with genetically closely related five patient and two HCW isolates differing in a single cgMLST allele at maximum. The outbreak was terminated after implementation of infection control bundle strategies. Although contact precaution measures, which are also part of MRSA prevention bundle strategies, were intensified during the COVID-19 pandemic, this MRSA outbreak could take place. This illustrates the importance of adherence to classical infection prevention strategies. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients)
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12 pages, 1525 KiB  
Article
Bacterial Coinfection and Antibiotic Resistance Profiles among Hospitalised COVID-19 Patients
by Abdulrahman S. Bazaid, Heba Barnawi, Husam Qanash, Ghaida Alsaif, Abdu Aldarhami, Hattan Gattan, Bandar Alharbi, Abdulaziz Alrashidi, Waleed Abu Al-Soud, Safia Moussa and Fayez Alfouzan
Microorganisms 2022, 10(3), 495; https://doi.org/10.3390/microorganisms10030495 - 23 Feb 2022
Cited by 40 | Viewed by 5279
Abstract
While it is reported that COVID-19 patients are more prone to secondary bacterial infections, which are strongly linked to the severity of complications of the disease, bacterial coinfections associated with COVID-19 are not widely studied. This work aimed to investigate the prevalence of [...] Read more.
While it is reported that COVID-19 patients are more prone to secondary bacterial infections, which are strongly linked to the severity of complications of the disease, bacterial coinfections associated with COVID-19 are not widely studied. This work aimed to investigate the prevalence of bacterial coinfections and associated antibiotic resistance profiles among hospitalised COVID-19 patients. Age, gender, weight, bacterial identities, and antibiotic sensitivity profiles were collected retrospectively for 108 patients admitted to the intensive care unit (ICU) and non-ICU ward of a single center in Saudi Arabia. ICU patients (60%) showed a significantly higher percentage of bacterial coinfections in sputum (74%) and blood (38%) samples, compared to non-ICU. Acinetobacter baumannii (56%) and Klebsiella pneumoniae (56%) were the most prevalent bacterial species from ICU patients, presenting with full resistance to all tested antibiotics except colistin. By contrast, samples of non-ICU patients exhibited infections with Escherichia coli (31%) and Pseudomonas aeruginosa (15%) predominantly, with elevated resistance of E. coli to piperacillin/tazobactam and trimethoprim/sulfamethoxazole. This alarming correlation between multi-drug resistant bacterial coinfection and admission to the ICU requires more attention and precaution with prescribed antibiotics to limit the spread of resistant bacteria and improve therapeutic management. Full article
(This article belongs to the Special Issue Antimicrobial Resistance and Outbreaks Due to Multidrug-resistant Bacteria in Hospitalized COVID-19 Patients)
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