The impact of COVID-19 on microbiological profile and antibiotic consumption in ICU: a retrospective study in an infectious disease hospital in Brazil.

BACKGROUND: The COVID-19 pandemic has triggered crises in the public health sector that have complex and multifaceted interrelationships with antimicrobial resistance. It is important to evaluate the impact of COVID-19 on microbiological profile, antibiotic and alcohol gel consumption in Intensive Care Units (ICU). METHODS: This is a retrospective study undertaken in an infectious disease hospital located in Bahia/Brazil during three periods: from March 2019 to February 2020; from March 2020 to February 2021; and from March 2021 to February 2022. It was evaluated the incidence density of Candida spp and of multidrug-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE group) in blood, urine and tracheal secretion isolated 48 h after the patient's admission to the ICU, as well as the use of alcohol gel (in milliliters) and consumption of antibiotics in Defined Daily Dose (DDD) per 1,000 ICU patient-days in the previous year and in the first two years of COVID-19 pandemic. RESULTS: There was an increase in Candida spp. (5.81, p < 0.001, IRR = 10.47, 95 % CI 2.57‒42.62) and in carbapenem-resistant A. baumannii in clinical cultures (4.71, p < 0.001, IRR = 8.46, 95 % CI 2.07‒34.60), the latter mainly in tracheal secretions (3.18, p= 0.02, IRR = 11.47, 95 % CI 1.58‒83.39). A rise in the consumption of ceftriaxone and piperacillin-tazobactam, along with an increase in the utilization of alcohol gel were observed. CONCLUSION: The shifting microbiological profile can be attributed to both the unique characteristics of patients with COVID-19 and the adjustments made to healthcare facilities' structural and work routines. Understanding these changes is essential in addressing the accelerated impact of antimicrobial resistance during the pandemic. Therefore, conducting thorough reviews of institutional practices and routines becomes critical in mitigating the consequences of antimicrobial resistance and its implications for patient care.

Streptococcus suis meningitis: An emerging zoonotic disease in Brazil.

Streptococcus suis has been widely reported as a pathogen in animals, especially pigs. In terms of human health implications, it has been characterized as a zoonosis associated with the consumption of pork products and occupational exposure, particularly in Southeast Asian countries. Here, we present a rare case of human S. suis infection in Brazil, diagnosed in an older adult swine farmer, a small rural producer residing in the semi-arid region of Bahia, Brazil.

Streptococcus suis meningitis: An emerging zoonotic disease in Brazil

ABSTRACT Streptococcus suis has been widely reported as a pathogen in animals, especially pigs. In terms of human health implications, it has been characterized as a zoonosis associated with the consumption of pork products and occupational exposure, particularly in Southeast Asian countries. Here, we present a rare case of human S. suis infection in Brazil, diagnosed in an older adult swine farmer, a small rural producer residing in the semi-arid region of Bahia, Brazil.

The impact of COVID-19 on microbiological profile and antibiotic consumption in ICU: a retrospective study in an infectious disease hospital in Brazil

Abstract Background The COVID-19 pandemic has triggered crises in the public health sector that have complex and multifaceted interrelationships with antimicrobial resistance. It is important to evaluate the impact of COVID-19 on microbiological profile, antibiotic and alcohol gel consumption in Intensive Care Units (ICU). Methods This is a retrospective study undertaken in an infectious disease hospital located in Bahia/Brazil during three periods: from March 2019 to February 2020; from March 2020 to February 2021; and from March 2021 to February 2022. It was evaluated the incidence density of Candida spp and of multidrug-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE group) in blood, urine and tracheal secretion isolated 48 h after the patient's admission to the ICU, as well as the use of alcohol gel (in milliliters) and consumption of antibiotics in Defined Daily Dose (DDD) per 1,000 ICU patient-days in the previous year and in the first two years of COVID-19 pandemic. Results There was an increase in Candida spp. (5.81, p < 0.001, IRR = 10.47, 95 % CI 2.57‒42.62) and in carbapenem-resistant A. baumannii in clinical cultures (4.71, p < 0.001, IRR = 8.46, 95 % CI 2.07‒34.60), the latter mainly in tracheal secretions (3.18, p =0.02, IRR = 11.47, 95 % CI 1.58‒83.39). A rise in the consumption of ceftriaxone and piperacillin-tazobactam, along with an increase in the utilization of alcohol gel were observed. Conclusion The shifting microbiological profile can be attributed to both the unique characteristics of patients with COVID-19 and the adjustments made to healthcare facilities' structural and work routines. Understanding these changes is essential in addressing the accelerated impact of antimicrobial resistance during the pandemic. Therefore, conducting thorough reviews of institutional practices and routines becomes critical in mitigating the consequences of antimicrobial resistance and its implications for patient care.

Avaliação da relação genética e perfil de sensibilidade de Klebsiella pneumoniae aos carbapenêmicos e a colistina em hospital terciário de Salvador

INTRODUÇÃO: Bactérias gram negativas multirresistentes, tais como a Klebsiella pneumoniae resistente aos carbapenêmicos e a colistina, representam um grande problema para os sistemas de saúde em todo o mundo e apresentam elevada letalidade. OBJETIVO: Avaliar a relação genética, perfil de sensibilidade antimicrobiana e mecanismos de resistência aos carbapenêmicos e à colistina em isolados de Klebsiella pneumoniae. MÉTODO: Série de casos de pacientes infectados/colonizados por cepas de Klebsiella pneumoniae resistente a carbapenêmicos e colistina (ColR-KPC) provenientes de um hospital terciário da cidade de Salvador, Bahia. No período de setembro de 2016 a janeiro de 2018 foram incluídos no estudo pacientes internados com idade igual ou superior a 18 anos. Utilizando questionário semiestruturado foram coletadas variáveis sociodemográficas e clínico-laboratoriais. Foram realizados testes fenotípicos e genotípicos em relação à resistência aos carbapenêmicos e colistina, e para verificar a disseminação dos isolados pelo hospital. RESULTADO: Foram identificadas 56 culturas de ColR-KPC pertencentes a 46 pacientes. Dados clínicos e demográficos foram obtidos de 31 pacientes. A mediana de idade foi 62, 67,7% eram homens (n=21/31), e mediana do escore de Charlson de 3. As principais comorbidades foram: hipertensão arterial sistêmica em 38,7% (n=14/31), diabetes 32,2% (n=10/31) e doença cerebrovascular em 25,8% (n=8/31). 90,6% (n=29/31) fez uso de ventilação mecânica e 93,7% (n=30/31) utilizou acesso venoso central. Dos 31 pacientes, 12 tiveram infecção por ColR-KPC e sete foram a óbito (58,4%). O uso prévio de polimixinas foi identificada em 32,2% (n=10/31) e de carbapenêmicos em 70,9% (n=22/31). Em relação aos 56 isolados, 67,8% (n=38/56) foram de swab retal, 8,9% (n=5/56) de hemoculturas, 7,1% (n=4/56) de ponta de cateter, 5,3% (n=3/56) secreção traqueal e 3,6% (n=2/56) urina. A CIM90 para colistina foi > 16 \03BCg/ml, sendo que mais da metade dos isolados (55%) tiveram a CIM de 256 \03BCg/ml. O gene blaKPC foi detectado em 92,8% dos isolados (n=52/56), blaNDM 16,0% (n=9/56) e blaGES 1,7% (n=1/56). Os genes blaOXA-48, blaVIM e blaIMP não foram detectados. A co-expressão de gene de carbapenemase foi encontrada entre blaKPC e blaNDM em 10,7%, (n=6/56), e blaKPC e blaGES em 1,7% (n=1/56). Alteração no gene mgrB foi detectado em 64,2% (n=36/56) e não-detecção em 8,9% (n=5/56). A pesquisa de mcr-1 foi negativa em todas os 56 isolados. O perfil do PFGE evidenciou perfil monoclonal em 84,7% dos isolados em diversos setores do hospital, sendo o ST-11 (CC-258) o tipo de sequência mais frequente. CONCLUSÃO: Pacientes infectados com ColR-KPC apresentaram elevada letalidade. A despeito das medidas de controle de infecção hospitalar, a transmissão horizontal parece ter contribuído para a disseminação da ColR-KPC ST-11 pelos diversos setores do hospital. Alterações/não detecção do genemgrB foram encontradas em 73,1% dos isolados, sugerindo que seja o principal mecanismo relacionado com a resistência às polimixinas neste estudo.