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Emerging Antibiotic Resistance in Nosocomial Pathogens: Current Trends and Future Directions

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Dear Colleagues,

The emergence of antibiotic resistance among pathogens responsible for nosocomial infections poses a critical threat to public health worldwide. Increasing resistance not only complicates treatment protocols but also contributes to extended hospital stays, heightened mortality rates, and a significant rise in healthcare costs. Factors such as the growing population of immunocompromised patients, the widespread use of indwelling medical devices, and the extensive application of antimicrobial agents in hospital settings have amplified the prevalence of resistant pathogens. The ESKAPE group—comprising Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species—represents a major concern. These pathogens are among the leading causes of life-threatening nosocomial infections in critically ill patients and are often characterized by multidrug resistance. The global dissemination of clonal strains of these pathogens has further exacerbated the challenge, with resistance rates particularly high in intensive care units. Contributing factors include the overuse of antibiotics, suboptimal infection control practices, and the prolonged hospitalization of vulnerable patients. This Special Issue seeks to explore the multifaceted problem of antimicrobial resistance in pathogens associated with nosocomial infections. By addressing its underlying causes, clinical implications, and potential strategies for mitigation, we aim at advancing the understanding and management of this pressing global health concern.

Dr. Kidon Sung
Guest Editor

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12 pages, 538 KB

Open AccessArticle

Temporal Trends and Mortality of Vancomycin-Resistant Enterococcus Bacteremia—A Six-Year Retrospective Cohort Study in a Tertiary Hospital in Greece

by Despoina Kypraiou, Angelos Sourris, Eirini Astrinaki, Efsevia Vitsaxaki, Stamatina Saplamidou, Maria Vakonaki, Kyriaki Tryfinopoulou, Georgios Chamilos, Petros Ioannou and Diamantis Kofteridis

Pathogens 2026, 15(5), 467; https://doi.org/10.3390/pathogens15050467 - 25 Apr 2026

Viewed by 593

Abstract

Background: Vancomycin-resistant Enterococcus (VRE) bacteremia represents a major therapeutic and epidemiological challenge, particularly in regions with high antimicrobial resistance rates such as Southern Europe. Longitudinal local data are essential to guide infection control and antimicrobial stewardship strategies. This study aimed to evaluate temporal trends in incidence, management, and mortality of VRE bacteremia in a tertiary care center in Greece over a six-year period, including comparison before and after the coronavirus disease 2019 (COVID-19) pandemic. Methods: This retrospective observational study included adult patients with VRE bacteremia at the University Hospital of Heraklion, Greece, from 2018 to 2023. Demographic and clinical data, such as the Pitt Bacteremia Index (PBI), as well as microbiological, and treatment data were collected from patient records. Incidence was calculated per 10,000 patient-days. Comparisons were performed between survivors and non-survivors and between pre- and post-COVID-19 eras. Multivariate regression analysis was used to identify predictors of in-hospital mortality. Results: A total of 96 patients were included (mean age 68.6 ± 14.5 years; 56.3% male). The incidence of VRE bacteremia increased more than five-fold during the study period, from 0.242 cases per 10,000 patient-days in 2018 to a peak of 1.344 per 10,000 patient-days in 2022, remaining elevated in 2023 (1.001 per 10,000 patient-days). The overall in-hospital mortality was 54.2%. Non-survivors had significantly higher PBI scores compared to survivors (median 2.5 vs. 0, p = 0.005). In the multivariate analysis, higher PBI was independently associated with in-hospital mortality [odds ratio: 1.449 (95% confidence intervals: 1.166–1.801)]. Appropriate empirical therapy was administered in 41.7% of cases and was not significantly associated with survival. Post-COVID-19 patients were older (69.9 vs. 61.4 years, p = 0.0365), and antimicrobial regimens were more frequently adjusted according to susceptibility testing (55.7% vs. 18.2%, p = 0.0141), but mortality did not significantly differ between periods. Conclusion: VRE bacteremia incidence increased dramatically over the six-year study period in our tertiary center, with persistently high mortality exceeding 50%. Severity of illness at the diagnosis of bacteremia, as measured by the PBI, was an independent predictor of in-hospital mortality. Strengthened infection prevention measures, optimized antimicrobial stewardship, and early aggressive management are urgently needed to mitigate the growing burden of VRE bacteremia. Full article

(This article belongs to the Special Issue Emerging Antibiotic Resistance in Nosocomial Pathogens: Current Trends and Future Directions)

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