This article systematically evaluates the impact of the pandemic on isolation rates, antibiotic resistance profiles, and usage patterns of multidrug-resistant (MDR) strains in tertiary healthcare institutions. It reveals challenges in antibiotic stewardship during the pandemic and highlights the potential risk of rising resistance, providing critical foundation for developing more rational antimicrobial management strategies.
Literature Overview
This article titled 'Increased Antimicrobial Consumption, Isolation Rate, and Resistance Profiles of Multi-Drug Resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii During the COVID-19 Pandemic in a Tertiary Healthcare Institution' published in Antibiotics reviews increased antibiotic consumption during the pandemic and tracks distribution changes of MDR strains. It analyzes evolving resistance trends and correlations with mechanical ventilation (MV) patient numbers. Based on data from the University Hospital Center in Serbia, this study provides empirical evidence for global antimicrobial stewardship challenges. The research specifically focuses on Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii - three representative Gram-negative pathogens responsible for nosocomial infections and resistance transmission. By analyzing 2019-2022 data, it establishes critical correlations between antimicrobial use, resistance evolution, and MV patient demographics.
Background Knowledge
Antimicrobial overuse during the pandemic became a global concern. While SARS-CoV-2 is viral, multiple guidelines initially recommended empirical antibiotic therapy for potential bacterial co-infections, causing surges in antimicrobial consumption. MDR strains are prevalent in hospital settings, particularly in ICUs, with complex resistance mechanisms closely tied to broad-spectrum antibiotic exposure. The study hospital in Serbia, serving as major referral center for severe COVID-19 cases, offers optimal conditions for analyzing these interrelated phenomena. These three Gram-negative bacterial species are specifically studied due to their clinical significance in healthcare-associated infections and resistance dissemination.
Research Methods and Experiments
This single-center retrospective study at University Hospital Center in Serbia divides the timeline into three periods: pre-pandemic (Period I: Apr 2019-Mar 2020), Pandemic Period II (Apr 2020-Mar 2021), and Pandemic Period III (Apr 2021-Mar 2022). Clinical samples from suspected infections (blood, respiratory, catheter, urine) underwent culture and antibiotic susceptibility testing using Vitek® 2 COMPACT system. Antimicrobial consumption was quantified using WHO's ATC/DDD methodology (Defined Daily Dose, DDD). Statistical analyses compared resistance patterns, MDR proportions, and antibiotic usage trends across periods, while establishing correlations between MV patient numbers and resistance evolution.
Key Conclusions and Perspectives
Research Significance and Prospects
This study demonstrates the pandemic's profound impact on MDR strain epidemiology, emphasizing urgent need for improved antimicrobial stewardship. It recommends optimizing antibiotic management in ICU settings, particularly for ventilated patients. Future research should focus on developing precise diagnostic tools to avoid empirical overuse and establish regional resistance surveillance networks to monitor evolving patterns.
Conclusion
This systematic analysis reveals significant increases in antimicrobial consumption and MDR proportions for KPN and PAE during the pandemic, while ABA maintained high resistance levels. Notably, 72% increase in total antibiotic use included substantial rises in carbapenems, fluoroquinolones, and glycopeptides. Correlation analysis confirms moderate positive relationships between MV patient numbers and resistance development in KPN and PAE, but not for ABA. These findings suggest the pandemic exacerbated nosocomial MDR transmission and underscore the necessity for enhanced antimicrobial stewardship programs. The study provides crucial empirical data for global infection control strategies and antibiotic management policies during public health emergencies.
