Title |
A pandemic within a pandemic? Admission to COVID-19 wards in hospitals is associated with increased prevalence of antimicrobial resistance in two African settings
|
---|---|
Published in |
Annals of Clinical Microbiology and Antimicrobials, April 2023
|
DOI | 10.1186/s12941-023-00575-1 |
Pubmed ID | |
Authors |
Linzy Elton, Muzamil Mahdi Abdel Hamid, John Tembo, Hana Elbadawi, Kwitaka Maluzi, Mohammed H. Abdelraheem, Teresa Cullip, Caren Kabanda, Kerry Roulston, Isobella Honeyborne, Margaret J Thomason, Kamal Elhag, Alaelddin Mohammed, Abdelsalam Adam, Kangwa Mulonga, Kapatiso Sikakena, Peter Matibula, Mwewa Kabaso, Ruth Nakazwe, Sombo Fwoloshi, Alimuddin Zumla, Timothy D McHugh |
Abstract |
Patients who develop severe illness due to COVID-19 are more likely to be admitted to hospital and acquire bacterial co-infections, therefore the WHO recommends empiric treatment with antibiotics. Few reports have addressed the impact of COVID-19 management on emergence of nosocomial antimicrobial resistance (AMR) in resource constrained settings. This study aimed to ascertain whether being admitted to a COVID-19 ward (with COVID-19 infection) compared to a non-COVID-19 ward (as a COVID-19 negative patient) was associated with a change in the prevalence of bacterial hospital acquired infection (HAI) species or resistance patterns, and whether there were differences in antimicrobial stewardship (AMS) and infection prevention and control (IPC) guidelines between COVID-19 and non-COVID-19 wards. The study was conducted in Sudan and Zambia, two resource constrained settings with differing country-wide responses to COVID-19. Patients suspected of having hospital acquired infections were recruited from COVID-19 wards and non-COVID-19 wards. Bacteria were isolated from clinical samples using culture and molecular methods and species identified. Phenotypic and genotypic resistance patterns were determined by antibiotic disc diffusion and whole genome sequencing. Infection prevention and control guidelines were analysed for COVID-19 and non-COVID-19 wards to identify potential differences. 109 and 66 isolates were collected from Sudan and Zambia respectively. Phenotypic testing revealed significantly more multi-drug resistant isolates on COVID-19 wards in both countries (Sudan p = 0.0087, Zambia p = 0.0154). The total number of patients with hospital acquired infections (both susceptible and resistant) increased significantly on COVID-19 wards in Sudan, but the opposite was observed in Zambia (both p = ≤ 0.0001). Genotypic analysis showed significantly more β-lactam genes per isolate on COVID-19 wards (Sudan p = 0.0192, Zambia p = ≤ 0.0001). Changes in hospital acquired infections and AMR patterns were seen in COVID-19 patients on COVID-19 wards compared to COVID-19 negative patients on non-COVID-19 wards in Sudan and Zambia. These are likely due to a potentially complex combination of causes, including patient factors, but differing emphases on infection prevention and control, and antimicrobial stewardship policies on COVID-19 wards were highlighted. |
X Demographics
As of 1 July 2024, you may notice a temporary increase in the numbers of X profiles with Unknown location. Click here to learn more.
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 2 | 12% |
Zambia | 1 | 6% |
Peru | 1 | 6% |
Unknown | 13 | 76% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 10 | 59% |
Scientists | 6 | 35% |
Science communicators (journalists, bloggers, editors) | 1 | 6% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 20 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 2 | 10% |
Student > Ph. D. Student | 2 | 10% |
Student > Doctoral Student | 1 | 5% |
Librarian | 1 | 5% |
Other | 1 | 5% |
Other | 1 | 5% |
Unknown | 12 | 60% |
Readers by discipline | Count | As % |
---|---|---|
Immunology and Microbiology | 2 | 10% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 5% |
Unspecified | 1 | 5% |
Agricultural and Biological Sciences | 1 | 5% |
Engineering | 1 | 5% |
Other | 0 | 0% |
Unknown | 14 | 70% |