Susceptibility of Austrian Clinical Klebsiella and Enterobacter Isolates Linked to Patient-Related Data

Badura, Alexandra; Pregartner, Gudrun; Holzer, Judith; Feierl, Gebhard; Grisold, Andrea

doi:10.3389/fmicb.2016.00034

“…About 52.81% of the patients aged more than 63 years, 57.29% of the patients aged less than 47 years, and 60.10% of the patients aged between 48 and 63 years were male. Several previous studies found that the susceptibility rates of bacteria to antibiotics in male patients are different than those in female patients [ 23 , 24 , 25 , 26 ]. Further studies are needed to assess the difference in bacterial resistance between males and females.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Susceptibility of Bacterial Pathogens Stratified by Age in a Public Hospital in Qassim

Alrebish

¹

,

Ahmed

²

,

Hamed

³

et al. 2022

Healthcare

2

0

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Antibiotics have completely transformed medical practice by enabling the treatment of infections that were formerly fatal. However, misuse of antibiotics encourages the formation and spread of germs that are resistant to therapy, hastening the emergence of bacterial resistance. This was a retrospective study that aimed to gather information about the variation in bacterial susceptibility of various patient age groups in a public hospital in Qassim, Saudi Arabia from January 2020 to December 2021. The study included reviewing bacterial susceptibility results that were collected from the laboratory department of the hospital. Four thousand seven hundred and sixty-two isolates were collected. The age of 46.41% of the patients was more than 63 years and the age of 28.96% of the patients was less than 48 years. The most prevalent bacteria were Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae. The resistance of gram-positive and gram-negative bacteria to different antibiotics in the elderly group was generally higher than the resistance rates in younger patients. For example, in patients less than 48 years old, the resistance of Staphylococcus haemolyticus to clindamycin (53.3%), ampicillin (91.4%), ciprofloxacin (68.2%), erythromycin (86.1%), and penicillin (93.18%) was high. In patients aged more than 63 years, Staphylococcus haemolyticus was highly resistant to sulfamethoxazole (54.8%), clindamycin (63.9%), ampicillin (98.1%), ciprofloxacin (79.1%), erythromycin (93.2%), gentamicin (63.6%), and penicillin (98.7%). Before prescribing the antibiotics, it is important to assess the microbes that patients have and to be aware of the bacterial isolates’ patterns of antibiotic susceptibility among patients of various age groups.

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“…Despite sex being a well-established risk factor for specific bacterial infections such as urinary tract infections, how prevalence of DRI varies between the sexes (and genders) is vastly underexplored in the literature [23]. This is despite many studies of infections caused by specific bacterial pathogens or syndromes finding a difference in resistance prevalence in infection between the sexes [24][25][26][27][28][29]. In 2018, the WHO called for countries to take the first step to better considering "gender and equity" in National Action Plans for AMR [30], which have historically lacked such considerations (e.g., in Southeast Asia [31]).…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance prevalence in bloodstream infection in 29 European countries by age and sex: An observational study

Waterlow,

Cooper,

Robotham

et al. 2024

PLoS Med

9

0

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Background Antibiotic usage, contact with high transmission healthcare settings as well as changes in immune system function all vary by a patient’s age and sex. Yet, most analyses of antimicrobial resistance (AMR) ignore demographic indicators and provide only country-level resistance prevalence values. This study aimed to address this knowledge gap by quantifying how resistance prevalence and incidence of bloodstream infection (BSI) varied by age and sex across bacteria and antibiotics in Europe. Methods and findings We used patient-level data collected as part of routine surveillance between 2015 and 2019 on BSIs in 29 European countries from the European Antimicrobial Resistance Surveillance Network (EARS-Net). A total of 6,862,577 susceptibility results from isolates with age, sex, and spatial information from 944,520 individuals were used to characterise resistance prevalence patterns for 38 different bacterial species and antibiotic combinations, and 47% of these susceptibility results were from females, with a similar age distribution in both sexes (mean of 66 years old). A total of 349,448 isolates from 2019 with age and sex metadata were used to calculate incidence. We fit Bayesian multilevel regression models by country, laboratory code, sex, age, and year of sample to quantify resistant prevalence and provide estimates of country-, bacteria-, and drug-family effect variation. We explore our results in greater depths for 2 of the most clinically important bacteria–antibiotic combinations (aminopenicillin resistance in Escherichia coli and methicillin resistance in Staphylococcus aureus) and present a simplifying indicative index of the difference in predicted resistance between old (aged 100) and young (aged 1). At the European level, we find distinct patterns in resistance prevalence by age. Trends often vary more within an antibiotic family, such as fluroquinolones, than within a bacterial species, such as Pseudomonas aeruginosa. Clear resistance increases by age for methicillin-resistant Staphylococcus aureus (MRSA) contrast with a peak in resistance to several antibiotics at approximately 30 years of age for P. aeruginosa. For most bacterial species, there was a u-shaped pattern of infection incidence with age, which was higher in males. An important exception was E. coli, for which there was an elevated incidence in females between the ages of 15 and 40. At the country-level, subnational differences account for a large amount of resistance variation (approximately 38%), and there are a range of functional forms for the associations between age and resistance prevalence. For MRSA, age trends were mostly positive, with 72% (n = 21) of countries seeing an increased resistance between males aged 1 and 100 years and a greater change in resistance in males. This compares to age trends for aminopenicillin resistance in E. coli which were mostly negative (males: 93% (n = 27) of countries see decreased resistance between those aged 1 and 100 years) with a smaller change in resistance in females. A change in resistance prevalence between those aged 1 and 100 years ranged up to 0.51 (median, 95% quantile of model simulated prevalence using posterior parameter ranges 0.48, 0.55 in males) for MRSA in one country but varied between 0.16 (95% quantile 0.12, 0.21 in females) to −0.27 (95% quantile −0.4, −0.15 in males) across individual countries for aminopenicillin resistance in E. coli. Limitations include potential bias due to the nature of routine surveillance and dependency of results on model structure. Conclusions In this study, we found that the prevalence of resistance in BSIs in Europe varies substantially by bacteria and antibiotic over the age and sex of the patient shedding new light on gaps in our understanding of AMR epidemiology. Future work is needed to determine the drivers of these associations in order to more effectively target transmission and antibiotic stewardship interventions.

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“…HIV) and bacterial infections such as urinary tract infections, how prevalence of drug-resistant infection (DRI) varies between the sexes (and genders) is vastly underexplored in the literature (20). This is despite many studies of single bacteria or syndromes finding a difference in resistance prevalence in infection between the sexes (21)(22)(23)(24)(25)(26). In 2018, the WHO called for countries to take the first step to better considering "gender and equity" in National Action Plans for AMR (27), which have historically lacked such considerations (e.g.…”

Section: Introductionmentioning

confidence: 99%

How demographic factors matter for antimicrobial resistance – quantification of the patterns and impact of variation in prevalence of resistance by age and sex

Waterlow,

Cooper,

Robotham

et al. 2023

Preprint

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BackgroundAntibiotic usage, contact with high transmission healthcare settings as well as changes in immune system function all vary by a patient’s age and sex. Yet, most analyses of antimicrobial resistance (AMR) ignore demographic indicators and provide only country level resistance prevalence values.In this work we use routine surveillance data on serious infections in Europe to characterise the importance of age and sex on incidence and resistance prevalence patterns for 33 different bacteria and antibiotic combinations. We fit Bayesian multilevel regression models to quantify these effects and provide estimates of country-, bacteria- and drug-family effect variation.ResultsAt the European level, we find distinct patterns in resistance prevalence by age that have previously not been explored in detail. Trends often vary more within an antibiotic family than within a bacterium: clear resistance increases by age for methicillin resistantS. aureus(MRSA) contrast with a peak in resistance to several antibiotics at ∼30 years of age forP. aeruginosa.This diverges from the known, clear exponential increase in infection incidence rates by age, which are higher for males except forE. coliat ages 15-40.At the country-level, the patterns are highly context specific with national and subnational differences accounting for a large amount of resistance variation (∼38%) and a range of associations between age and resistance prevalence. We explore our results in greater depths for two of the most clinically important bacteria–antibiotic combinations. For MRSA, age trends were mostly positive, with 72% of countries seeing an increased resistance between males aged 1 and 100 and more resistance in males. This compares to age trends for aminopenicillin resistance inE. coliwhich were mostly negative (males: 93% of countries see decreased resistance between ages 1 and 100) with more resistance in females. A change in resistance prevalence between ages 1 and 100 ranged up to ∼0.46 (95% CI 0.37 – 0.51, males) for MRSA but varied between 0.16 (95% CI 0.23-0.3, females) to -0.27 (95%CI -0.4 - - 0.15, males) across individual countries for aminopenicillin resistance inE. coli.ConclusionPrevalence of resistance in infection varies substantially by the age and sex of the individual revealing gaps in our understanding of AMR epidemiology. These context-specific patterns should now be exploited to improve intervention targeting as well as our understanding of AMR dynamics.

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Susceptibility of Austrian Clinical Klebsiella and Enterobacter Isolates Linked to Patient-Related Data

Cited by 3 publications

References 23 publications

Antibiotic Susceptibility of Bacterial Pathogens Stratified by Age in a Public Hospital in Qassim

Antibiotic Susceptibility of Bacterial Pathogens Stratified by Age in a Public Hospital in Qassim

Antimicrobial resistance prevalence in bloodstream infection in 29 European countries by age and sex: An observational study

How demographic factors matter for antimicrobial resistance – quantification of the patterns and impact of variation in prevalence of resistance by age and sex

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