Microbiological profile of multidrug resistant bacteria before and during COVID-19 in CHU Mohammed VI
,
Abstract
Background and Objectives: A new type of corona virus has caused Corona virus disease-19 and, subsequently, a global pandemic. All individuals are prone to the disease, so drastic measures were taken to prevent its spread. This study aimed to evaluate the impact of COVID-19 on the progression of the antimicrobial resistance rate by comparing two periods: before and during COVID-19.
Materials and Methods: We used a cross-sectional design to investigate the Antimicrobial Resistance (AMR) rate before (03/2019 to 03/2020) and during COVID-19 (03/2020 to 03/2021) in a University Hospital in Marrakech. The data were analyzed using SPSS Version 25.0.
Results: Among the 7106 specimens, there was a significant increase in the multidrug-resistant bacterial from 27.38% to 35.87% during COVID-19 (p<0.001), particularly in blood culture, cerebrospinal fluid, catheter, and pus. However, there was a non-significant change in puncture fluid, expectoration, protected distal sampling, joint fluid, stool culture, and genital sampling. A decrease in Multidrug-resistant bacteria (MDRB) was observed only in cytobacteriological urine tests (p<0.05). According to species, there was an increase in extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus.
Conclusion: In our study, it is particularly noticeable that the MDRB has increased. These results highlight the importance that the pandemic has not been able to slow the progression.
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3. Carter B, Collins JT, Barlow-Pay F, Rickard F, Bruce E, Verduri A, et al. Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-nosocomial study (COVID in Older PEople). J Hosp Infect 2020; 106: 376-384.
4. Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, et al. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol 2020; 104: 7777-7785.
5. Zhou Q, Gao Y, Wang X, Liu R, Du P, Wang X, et al. Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis. Ann Transl Med 2020; 8: 629.
6. Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science 2020; 368: 489-493.
7. Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta 2020; 508: 254-266.
8. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet 2011; 377: 1264-1275.
9. Shen Z, Xiao Y, Kang L, Ma W, Shi L, Zhang L, et al. Genomic diversity of severe acute respiratory syndrome–Coronavirus 2 in patients with Coronavirus disease 2019. Clin Infect Dis 2020; 71: 713-720.
10. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46: 846-848.
11. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with Coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020; 71: 2459-2468.
12. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19): A review. JAMA 2020; 324: 782-793.
13. Del Pozo JL. Respiratory co-and superinfections in COVID-19. Rev Esp Quimioter 2021; 34 Suppl 1(Suppl1): 69-71.
14. Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect 2020; 104: 454-455.
15. Strathdee SA, Davies SC, Marcelin JR. Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election. Lancet 2020; 396: 1050-1053.
16. “US Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019.” Available at: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
17. Oussayeh I, Moussaid F, Traoré AO, Touiti A, Elkhayari M, Soraa N, et al. Epidemiology, risk factors and outcomes of multidrug-resistant bacteria colonization in a Moroccan medical intensive care unit. PAMJ Clin Med 2021; 5: 33.
18. Minister of Health of Morocco, 2020. Available at: https://www.sante.gov.ma/Pages/communiqu%C3%A9s.aspx?communiqueID=355 (Accessible 03/09/2023)
19. Monnet DL, Harbarth S. Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance? Euro Surveill 2020; 25: 2001886.
20. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56-66.
21. Cantón R, Gijón D, Ruiz-Garbajosa P. Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic. Curr Opin Crit Care 2020; 26: 433-441.
22. Donà D, Di Chiara C, Sharland M. Multi-drug-resistant infections in the COVID-19 era: a framework for considering the potential impact. J Hosp Infect 2020; 106: 198-199.
23. Getahun H, Smith I, Trivedi K, Paulin S, Balkhy HH. Tackling antimicrobial resistance in the COVID-19 pandemic. Bull World Health Organ 2020; 98: 442-442A.
24. Murray AK. The Novel Coronavirus COVID-19 Outbreak: Global Implications for antimicrobial resistance. Front Microbiol 2020; 11: 1020.
25. Kampmeier S, Tönnies H, Correa-Martinez CL, Mellmann A, Schwierzeck V. A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit. Antimicrob Resist Infect Control 2020; 9: 154.
26. Nori P, Szymczak W, Puius Y, Sharma A, Cowman K, Gialanella P, et al. Emerging co-pathogens: New Delhi metallo-beta-lactamase producing Enterobacterales infections in New York City COVID-19 patients. Int J Antimicrob Agents 2020; 56: 106179.
27. Porretta AD, Baggiani A, Arzilli G, Casigliani V, Mariotti T, Mariottini F, et al. Increased risk of acquisition of New Delhi Metallo-Beta-Lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) among a Cohort of COVID-19 patients in a teaching Hospital in Tuscany, Italy. Pathogens 2020; 9: 635.
28. Tiri B, Sensi E, Marsiliani V, Cantarini M, Priante G, Vernelli C, et al. Antimicrobial stewardship program, COVID-19, and infection control: spread of carbapenem-resistant Klebsiella Pneumoniae colonization in ICU COVID-19 patients. What Did Not Work? J Clin Med 2020; 9: 2744.
29. Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically Ill Coronavirus disease patients, India, April–July 2020. Emerg Infect Dis 2020; 26: 2694-2696.
30. Posteraro B, Torelli R, Vella A, Leone PM, De Angelis G, De Carolis E, et al. Pan-echinocandin-resistant Candida glabrata bloodstream infection complicating COVID-19: A fatal case report. J Fungi (Basel) 2020; 6: 163.
31. Meijer EFJ, Dofferhoff ASM, Hoiting O, Buil JB, Meis JF. Azole-resistant COVID-19-associated pulmonary Aspergillosis in an immunocompetent host: A case report. J Fungi (Basel) 2020; 6: 79.
32. Contou D, Claudinon A, Pajot O, Micaëlo M, Longuet Flandre P, Dubert M, et al. Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU. Ann Intensive Care 2020; 10: 119.
33. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect 2021; 27: 83-88.
34. Fattorini L, Creti R, Palma C, Pantosti A. Unit of antibiotic resistance and special pathogens, unit of antibiotic resistance and special pathogens of the department of infectious diseases, Istituto Superiore di Sanità, Rome. Bacterial coinfections in COVID-19: an underestimated adversary. Ann Ist Super Sanita 2020; 56: 359-364.
35. Collignon P, Beggs JJ. CON: COVID-19 will not result in increased antimicrobial resistance prevalence. JAC Antimicrob Resist 2020; 2: dlaa051.
36. Santoli JM, Lindley MC, DeSilva MB, Kharbanda EO, Daley MF, Galloway L, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 591-593.
37. Kampf G. Biocidal agents used for disinfection can enhance antibiotic resistance in Gram-negative species. Antibiotics (Basel) 2018; 7: 110.
38. Mulholland RH, Wood R, Stagg HR, Fischbacher C, Villacampa J, Simpson CR, et al. Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis. J R Soc Med 2020; 113: 444-453.
39. Pines JM, Zocchi MS, Black BS, Celedon P, Carlson JN, Moghtaderi A, et al. The effect of the COVID-19 pandemic on emergency department visits for serious cardiovascular conditions. Am J Emerg Med 2021; 47: 42-51.
40. Mitchell BG, Hall L, White N, Barnett AG, Halton K, Paterson DL, et al. An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial. Lancet Infect Dis 2019; 19: 410-418.
41. Dancer SJ. Controlling Hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014; 27: 665-690.
42. Sharma A, Ahmad Farouk I, Lal SK. COVID-19: A review on the novel Coronavirus sisease evolution, transmission, detection, control and prevention. Viruses 2021; 13: 202.
2. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel Coronavirus from patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733.
3. Carter B, Collins JT, Barlow-Pay F, Rickard F, Bruce E, Verduri A, et al. Nosocomial COVID-19 infection: examining the risk of mortality. The COPE-nosocomial study (COVID in Older PEople). J Hosp Infect 2020; 106: 376-384.
4. Chen X, Liao B, Cheng L, Peng X, Xu X, Li Y, et al. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol 2020; 104: 7777-7785.
5. Zhou Q, Gao Y, Wang X, Liu R, Du P, Wang X, et al. Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis. Ann Transl Med 2020; 8: 629.
6. Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science 2020; 368: 489-493.
7. Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta 2020; 508: 254-266.
8. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet 2011; 377: 1264-1275.
9. Shen Z, Xiao Y, Kang L, Ma W, Shi L, Zhang L, et al. Genomic diversity of severe acute respiratory syndrome–Coronavirus 2 in patients with Coronavirus disease 2019. Clin Infect Dis 2020; 71: 713-720.
10. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46: 846-848.
11. Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, et al. Bacterial and fungal coinfection in individuals with Coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis 2020; 71: 2459-2468.
12. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19): A review. JAMA 2020; 324: 782-793.
13. Del Pozo JL. Respiratory co-and superinfections in COVID-19. Rev Esp Quimioter 2021; 34 Suppl 1(Suppl1): 69-71.
14. Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect 2020; 104: 454-455.
15. Strathdee SA, Davies SC, Marcelin JR. Confronting antimicrobial resistance beyond the COVID-19 pandemic and the 2020 US election. Lancet 2020; 396: 1050-1053.
16. “US Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019.” Available at: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
17. Oussayeh I, Moussaid F, Traoré AO, Touiti A, Elkhayari M, Soraa N, et al. Epidemiology, risk factors and outcomes of multidrug-resistant bacteria colonization in a Moroccan medical intensive care unit. PAMJ Clin Med 2021; 5: 33.
18. Minister of Health of Morocco, 2020. Available at: https://www.sante.gov.ma/Pages/communiqu%C3%A9s.aspx?communiqueID=355 (Accessible 03/09/2023)
19. Monnet DL, Harbarth S. Will coronavirus disease (COVID-19) have an impact on antimicrobial resistance? Euro Surveill 2020; 25: 2001886.
20. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56-66.
21. Cantón R, Gijón D, Ruiz-Garbajosa P. Antimicrobial resistance in ICUs: an update in the light of the COVID-19 pandemic. Curr Opin Crit Care 2020; 26: 433-441.
22. Donà D, Di Chiara C, Sharland M. Multi-drug-resistant infections in the COVID-19 era: a framework for considering the potential impact. J Hosp Infect 2020; 106: 198-199.
23. Getahun H, Smith I, Trivedi K, Paulin S, Balkhy HH. Tackling antimicrobial resistance in the COVID-19 pandemic. Bull World Health Organ 2020; 98: 442-442A.
24. Murray AK. The Novel Coronavirus COVID-19 Outbreak: Global Implications for antimicrobial resistance. Front Microbiol 2020; 11: 1020.
25. Kampmeier S, Tönnies H, Correa-Martinez CL, Mellmann A, Schwierzeck V. A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit. Antimicrob Resist Infect Control 2020; 9: 154.
26. Nori P, Szymczak W, Puius Y, Sharma A, Cowman K, Gialanella P, et al. Emerging co-pathogens: New Delhi metallo-beta-lactamase producing Enterobacterales infections in New York City COVID-19 patients. Int J Antimicrob Agents 2020; 56: 106179.
27. Porretta AD, Baggiani A, Arzilli G, Casigliani V, Mariotti T, Mariottini F, et al. Increased risk of acquisition of New Delhi Metallo-Beta-Lactamase-producing carbapenem-resistant Enterobacterales (NDM-CRE) among a Cohort of COVID-19 patients in a teaching Hospital in Tuscany, Italy. Pathogens 2020; 9: 635.
28. Tiri B, Sensi E, Marsiliani V, Cantarini M, Priante G, Vernelli C, et al. Antimicrobial stewardship program, COVID-19, and infection control: spread of carbapenem-resistant Klebsiella Pneumoniae colonization in ICU COVID-19 patients. What Did Not Work? J Clin Med 2020; 9: 2744.
29. Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-resistant Candida auris infections in critically Ill Coronavirus disease patients, India, April–July 2020. Emerg Infect Dis 2020; 26: 2694-2696.
30. Posteraro B, Torelli R, Vella A, Leone PM, De Angelis G, De Carolis E, et al. Pan-echinocandin-resistant Candida glabrata bloodstream infection complicating COVID-19: A fatal case report. J Fungi (Basel) 2020; 6: 163.
31. Meijer EFJ, Dofferhoff ASM, Hoiting O, Buil JB, Meis JF. Azole-resistant COVID-19-associated pulmonary Aspergillosis in an immunocompetent host: A case report. J Fungi (Basel) 2020; 6: 79.
32. Contou D, Claudinon A, Pajot O, Micaëlo M, Longuet Flandre P, Dubert M, et al. Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU. Ann Intensive Care 2020; 10: 119.
33. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect 2021; 27: 83-88.
34. Fattorini L, Creti R, Palma C, Pantosti A. Unit of antibiotic resistance and special pathogens, unit of antibiotic resistance and special pathogens of the department of infectious diseases, Istituto Superiore di Sanità, Rome. Bacterial coinfections in COVID-19: an underestimated adversary. Ann Ist Super Sanita 2020; 56: 359-364.
35. Collignon P, Beggs JJ. CON: COVID-19 will not result in increased antimicrobial resistance prevalence. JAC Antimicrob Resist 2020; 2: dlaa051.
36. Santoli JM, Lindley MC, DeSilva MB, Kharbanda EO, Daley MF, Galloway L, et al. Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration — United States, 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 591-593.
37. Kampf G. Biocidal agents used for disinfection can enhance antibiotic resistance in Gram-negative species. Antibiotics (Basel) 2018; 7: 110.
38. Mulholland RH, Wood R, Stagg HR, Fischbacher C, Villacampa J, Simpson CR, et al. Impact of COVID-19 on accident and emergency attendances and emergency and planned hospital admissions in Scotland: an interrupted time-series analysis. J R Soc Med 2020; 113: 444-453.
39. Pines JM, Zocchi MS, Black BS, Celedon P, Carlson JN, Moghtaderi A, et al. The effect of the COVID-19 pandemic on emergency department visits for serious cardiovascular conditions. Am J Emerg Med 2021; 47: 42-51.
40. Mitchell BG, Hall L, White N, Barnett AG, Halton K, Paterson DL, et al. An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial. Lancet Infect Dis 2019; 19: 410-418.
41. Dancer SJ. Controlling Hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014; 27: 665-690.
42. Sharma A, Ahmad Farouk I, Lal SK. COVID-19: A review on the novel Coronavirus sisease evolution, transmission, detection, control and prevention. Viruses 2021; 13: 202.
| Files | ||
| Issue | Vol 15 No 6 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v15i6.14138 | |
| Keywords | ||
| Multidrug resistant bacteria; Antimicrobial resistance; Rate; Corona virus disease-19; Microbiological profile | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bennani H, Guennouni M, Ouarradi A, Lamrani Hanchi A, Soraa N. Microbiological profile of multidrug resistant bacteria before and during COVID-19 in CHU Mohammed VI. Iran J Microbiol. 2023;15(6):771-778.
