Burden of multidrug and extensively drug-resistant ESKAPEE pathogens in a secondary hospital care setting in Greece
Our latest research was just published in Epidemiology and Infection, 23 September 2022.
"Burden of multidrug and extensively drug-resistant ESKAPEE pathogens in a secondary hospital care setting in Greece"
Evangelos I Kritsotakis, Dimitra Lagoutari, Efstratios Michailellis, Ioannis Georgakakis, and Achilleas Gikas
Figure: Cumulative incidence functions for in-hospital mortality (on the left) and discharge alive (on the right) by antimicrobial resistance level in ESKAPEE organisms isolated from blood in 226 patients. Lower incidence of hospital discharge alive indicates longer hospitalization after bacteraemia onset. MDR, multidrug resistant; XDR extensively drug resistant.
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Abstract
Bacterial antibiotic resistance (AMR) is a significant threat to public health, with the sentinel "ESKAPEE" pathogens, being of particular concern. A cohort study spanning 5.5 years (2016 to 2021) was conducted at a provincial general hospital in Crete, Greece, to describe the epidemiology of ESKAPEE-associated bacteraemia regarding levels of AMR and their impact on patient outcomes. In total, 239 bloodstream isolates were examined from 226 patients (0.7% of 32,996 admissions) with a median age of 75 years, 28% of whom had severe comorbidity, and 46% with prior stay in ICU. Multidrug resistance (MDR) was lowest for Pseudomonas aeruginosa (30%) and Escherichia coli (33%), and highest among Acinetobacter baumannii (97%); the latter included 8 (22%) with extensive drug-resistance (XDR), half of which were resistant to all antibiotics tested. MDR bacteraemia was more likely to be healthcare-associated than community-onset (RR 1.67, 95%CI 1.04-2.65). Inpatient mortality was 22%, 35% and 63% for non-MDR, MDR and XDR episodes, respectively (p=0.004). Competing risks survival analysis revealed increasing mortality linked to longer hospitalization with increasing AMR levels, as well as differential pathogen-specific effects. A.baumannii bacteraemia was the most fatal (14-day death hazard ratio 3.39, 95%CI 1.74-6.63). Differences in microbiology, AMR profile and associated mortality compared to national and international data emphasize the importance of similar investigations of local epidemiology.
Key words
Microbial drug resistance; ESKAPE; mortality; secondary care; hospital epidemiology; survival analysis.