Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy
Abstract
:1. Introduction
2. Results
2.1. Sample General Characteristics
2.2. Gram-Positive AMR Pattern
2.3. Gram-Negative AMR Pattern
2.4. Binomial Logistic Regression Analysis
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Study Setting
4.3. Data Source
4.4. Blood Culture and AST
4.5. Statistical Analysis
4.6. Ethics Statement
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Antimicrobial Category | Antimicrobial Agents | CoNS | Staphylococcus aureus | Enterococcus faecalis | Enterococcus faecium | Total | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
N = 366 | (%) | N = 235 | (%) | N = 72 | (%) | N = 34 | (%) | N = 707 | (%) | ||
Penicillins | PEN | 175 | (47.8) | 146 | (62.1) | 14 | (19.4) | 19 | (55.9) | 354 | (50.4) |
OXA | 116 | (31.7) | 66 | (28.1) | NT | NT | 182 | (30.3) 1 | |||
Fluoroquinolones | CIP | 52 | (14.2) | 39 | (16.6) | 12 | (16.7) | 8 | (23.5) | 111 | (15.7) |
LVX | 141 | (38.5) | 77 | (32.8) | 28 | (38.9) | 12 | (35.3) | 258 | (36.5) | |
Aminoglycosides | GEN | 145 | (39.6) | 78 | (33.2) | - 2 | - 2 | 223 | (37.1) 1 | ||
HLG | NT | NT | 37 | (51.4) | 15 | (44.1) | 52 | (49.1) 1 | |||
Macrolides | ERY | 164 | (44.8) | 83 | (35.3) | 23 | (31.9) | 10 | (29.4) | 280 | (39.6) |
Lincosamides | CLI | 137 | (37.4) | 69 | (29.4) | - 2 | - 2 | 206 | (34.3)1 | ||
Tetracyclines | TET | 88 | (24) | 43 | (18.3) | 12 | (16.7) | 7 | (20.6) | 150 | (21.2) |
Folate pathway inhibitors | SXT | 96 | (26.2) | 53 | (22.6) | - 2 | - 2 | 149 | (24.8) 1 | ||
Glycopeptides | VAN | 9 | (2.5) | 7 | (3) | 0 | 1 | (2.9) | 17 | (2.4) | |
TEC | 59 | (16.1) | 33 | (14) | 6 | (8.3) | 3 | (8.8) | 101 | (14.3) | |
Oxazolidinones | LZD | 18 | (4.9) | 7 | (3) | 0 | 0 | 25 | (3.5) | ||
Lipopeptides | DAP | 23 | (6.3) | 20 | (8.5) | 7 | (9.7) | 0 | 50 | (7.1) |
AMR Pattern 1 | CoNS | S. aureus | Total | |||
---|---|---|---|---|---|---|
N = 366 | (%) | N = 235 | (%) | N = 601 | (%) | |
Resistance to two antimicrobial categories | ||||||
Penicillins + Aminoglycosides | 120 | (68.6) | 67 | (45.9) | 187 | (31.1) |
Penicillins + Fluoroquinolones | 99 | (27) | 55 | (23.4) | 154 | (25.6) |
Aminoglycosides + Fluoroquinolones | 80 | (21.9) | 32 | (13.6) | 112 | (18.6) |
Resistance to three antimicrobial categories | ||||||
Penicillins + Aminoglycosides + Fluoroquinolones | 71 | (19.4) | 29 | (12.3) | 100 | (16.6) |
Penicillins + Aminoglycosides + Glycopeptides | 30 | (8.2) | 17 | (7.2) | 47 | (7.8) |
Penicillins + Fluoroquinolones + Glycopeptides | 27 | (7.4) | 19 | (8.1) | 46 | (7.6) |
Resistance to four antimicrobial categories | ||||||
Penicillins + Aminoglycosides + Fluoroquinolones + Glycopeptides | 24 | (6.6) | 15 | (6.4) | 39 | (6.5) |
Antimicrobial Category | Antimicrobial Agent | E. coli | K. pneumoniae | A. baumannii | P. aeruginosa | Others Gram-Negative Organisms 1 | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N = 196 | (%) | N = 147 | (%) | N = 91 | (%) | N = 41 | (%) | N = 46 | (%) | N = 521 | (%) | ||
Penicillins | AMP | 79 | (40.3) | 91 | (61.9) | 44 | (48.4) | 15 | (36.6) | 11 | (23.9) | 240 | (46.1) |
Penicillins + β-lactamase inhibitors | AMX | 66 | (33.7) | 91 | (61.9) | 9 | (9.9) | 5 | (12.2) | 20 | (43.5) | 191 | (36.7) |
TZP | 33 | (16.8) | 61 | (41.5) | 17 | (18.7) | 8 | (19.5) | 11 | (23.9) | 130 | (25) | |
2nd generation cephalosporins | CXM | 21 | (10.7) | 12 | (8.2) | 3 | (3.3) | - | - | 36 | (8.3) 2 | ||
FOX | 16 | (8.2) | 35 | (23.8) | 20 | (22) | 2 | (4.9) | 3 | (6.5) | 76 | (14.6) | |
3rd or 4th generation cephalosporins | CTX | 53 | (27) | 83 | (56.5) | 41 | (45.1) | 10 | (24.4) | 20 | (43.5) | 207 | (39.7) |
CAZ | 59 | (30.1) | 84 | (57.1) | 8 | (8.8) | 7 | (17.1) | 19 | (41.3) | 177 | (34) | |
CPM | 31 | (15.8) | 46 | (31.3) | 15 | (16.5) | 5 | (12.2) | 13 | (28.3) | 110 | (21.1) | |
Aminoglycosides | AMK | 17 | (8.7) | 62 | (42.2) | 27 | (29.7) | 4 | (9.8) | 12 | (26.1) | 122 | (23.4) 2 |
GEN | 63 | (32.1) | 77 | (52.4) | 51 | (56) | 9 | (22) | 14 | (30.4) | 214 | (41.1) | |
Fluoroquinolones | CIP | 92 | (46.9) | 102 | (69.4) | 53 | (58.2) | 9 | (22) | 24 | (52.2) | 280 | (53.7) |
Carbapenems | IMP | 13 | (6.6) | 45 | (30.6) | 16 | (17.6) | 2 | (4.9) | 5 | (10.9) | 81 | (15.5) |
MEM | 17 | (8.7) | 54 | (36.7) | 23 | (25.3) | 5 | (12.2) | 10 | (21.7) | 109 | (20.9) | |
ETP | 14 | (7.1) | 41 | (27.9) | 15 | (16.5) | 4 | (9.8) | 7 | (15.2) | 81 | (15.6) | |
Glycylcyclines | TGC | 22 | (11.2) | 45 | (30.6) | 14 | (15.4) | 15 | (36.6) | 8 | (17.4) | 104 | (20) |
Folate pathway inhibitors | SXT | 50 | (25.5) | 59 | (40.1) | 39 | (42.9) | 15 | (36.6) | 16 | (34.8) | 179 | (34.4) |
Polymyxins | CST | 16 | (8.2) | 27 | (18.4) | 5 | (5.5) | 2 | (4.9) | 8 | (17.4) | 58 | (11.1) |
AMR Pattern 1 | E. coli | K. pneumoniae | A. baumannii | P. aeruginosa | Others Gram-Negative Organisms 2 | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
N = 196 | (%) | N = 147 | (%) | N = 91 | (%) | N = 41 | (%) | N = 46 | (%) | N = 521 | (%) | |
Resistance to two antimicrobial categories | ||||||||||||
Carbapenems + Aminoglycosides | 20 | (10.2) | 53 | (36.1) | 22 | (24.2) | 4 | (9.8) | 9 | (19.6) | 108 | (20.7) |
Carbapenems + Fluoroquinolones | 19 | (9.7) | 56 | (38.1) | 21 | (23.1) | 3 | (7.3) | 10 | (21.7) | 109 | (20.9) |
3rd or 4th generation cephalosporins + Aminoglycosides | 31 | (15.8) | 72 | (49) | 13 | (14.3) | 3 | (7.3) | 11 | (23.9) | 130 | (25) |
3rd or 4th generation cephalosporins + Fluoroquinolones | 58 | (29.6) | 84 | (57.1) | 12 | (13.2) | 5 | (12.2) | 17 | (37) | 176 | (33.8) |
Aminoglycosides + Fluoroquinolones | 41 | (20.9) | 83 | (56.5) | 44 | (48.4) | 6 | (14.6) | 16 | (34.8) | 190 | (36.5) |
Resistance to three antimicrobial categories | ||||||||||||
Carbapenems + Aminoglycosides + Fluoroquinolones | 18 | (9.2) | 51 | (34.7) | 20 | (22) | 3 | (7.3) | 9 | (19.6) | 101 | (19.4) |
3rd or 4th generation cephalosporins + Aminoglycosides + Fluoroquinolones | 27 | (13.8) | 69 | (46.9) | 11 | (12.1) | 3 | (7.3) | 11 | (23.9) | 121 | (23.2) |
Resistance to four antimicrobial categories | ||||||||||||
Carbapenems + Aminoglycosides + Fluoroquinolones + Polymyxins | 3 | (1.5) | 17 | (11.6) | 1 | (1.1) | 0 | (-) | 0 | (-) | 21 | (4) |
3rd or 4th generation cephalosporins + Aminoglycosides + Fluoroquinolones + Polymyxins | 2 | (1) | 22 | (15) | 1 | (1.1) | 0 | (-) | 2 | (4.3) | 28 | (5.4) |
Blood Culture Isolates | Gender 1 | Age (10 Years Increase) | Wards 2 | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Medical Wards | Surgical Wards | Emergency Rooms | ||||||||
Outcome | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
CoNS | 1.12 | 0.85–1.46 | 0.91 | 0.86–0.96 | 0.65 | 0.49–0.86 | 0.21 | 0.11–0.43 | 0.26 | 0.15–0.46 |
S. aureus | 1.14 | 0.84–1.54 | 1.05 | 0.98–1.13 | 1.42 | 1.01–2.00 | 1.79 | 1.03–3.12 | 2.00 | 1.23–3.27 |
Enterococcus species | 1.01 | 0.66–1.55 | 1.02 | 0.92–1.12 | 1.37 | 0.84–2.24 | 1.40 | 0.62–3.16 | 1.82 | 0.92–3.59 |
E. coli | 1.08 | 0.77–1.50 | 1.08 | 0.98–1.18 | 5.37 | 3.34–8.66 | 5.28 | 2.72–10.23 | 6.58 | 3.63–11.94 |
K. pneumoniae | 0.85 | 0.58–1.24 | 1.01 | 1.01–1.20 | 0.49 | 0.32–0.75 | 1.65 | 0.94–2.90 | 0.57 | 0.29–1.09 |
A. baumannii | 0.70 | 0.42–1.16 | 0.97 | 0.89–1.06 | 0.24 | 0.14–0.42 | 0.15 | 0.04–0.64 | NE | NE |
P. aeruginosa | 0.85 | 0.41–1.77 | 1.00 | 0.84–1.18 | 2.03 | 0.88–4.70 | NE | NE | 2.79 | 0.93–8.32 |
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Licata, F.; Quirino, A.; Pepe, D.; Matera, G.; Bianco, A.; Collaborative Group. Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy. Antibiotics 2021, 10, 10. https://doi.org/10.3390/antibiotics10010010
Licata F, Quirino A, Pepe D, Matera G, Bianco A, Collaborative Group. Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy. Antibiotics. 2021; 10(1):10. https://doi.org/10.3390/antibiotics10010010
Chicago/Turabian StyleLicata, Francesca, Angela Quirino, Davide Pepe, Giovanni Matera, Aida Bianco, and Collaborative Group. 2021. "Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy" Antibiotics 10, no. 1: 10. https://doi.org/10.3390/antibiotics10010010