Antibiotic use during coronavirus disease 2019 intensive care unit shape multidrug resistance bacteriuria: A Swedish longitudinal prospective study

Frontiers in Medicine

Medicine

Julia Pärssinen¹  Nikos Fatsis-Kavalopoulos¹  Helen Wang¹  Philip A. Karlsson²  Josef D. Järhult³  Erik A. Danielsson⁴  Robert Frithiof⁴  Michael Hultström⁵  Miklos Lipcsey⁶ 

[1] Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden;Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden;Department of Medical Sciences, Zoonosis Science Center, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden;Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden;Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden;Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden;

关键词: UTI;    ICU–intensive care unit;    COVID-19;    MDR–(multidrug resistance);    AMR;    antibiotic treatment;    catheters;   

DOI  :  10.3389/fmed.2023.1087446

 received in 2022-11-02, accepted in 2023-01-23,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectivesHigh frequency of antimicrobial prescription and the nature of prolonged illness in COVID-19 increases risk for complicated bacteriuria and antibiotic resistance. We investigated risk factors for bacteriuria in the ICU and the correlation between antibiotic treatment and persistent bacteria.MethodsWe conducted a prospective longitudinal study with urine from indwelling catheters of 101 ICU patients from Uppsala University Hospital, Sweden. Samples were screened and isolates confirmed with MALDI-TOF and whole genome sequencing. Isolates were analyzed for AMR using broth microdilution. Clinical data were assessed for correlation with bacteriuria.ResultsLength of stay linearly correlated with bacteriuria (R2 = 0.99, p ≤ 0.0001). 90% of patients received antibiotics, primarily the beta-lactams (76%) cefotaxime, piperacillin-tazobactam, and meropenem. We found high prevalence of Enterococcus (42%) being associated with increased cefotaxime prescription. Antibiotic-susceptible E. coli were found to cause bacteriuria despite concurrent antibiotic treatment when found in co-culture with Enterococcus.ConclusionLonger stays in ICUs increase the risk for bacteriuria in a predictable manner. Likely, high use of cefotaxime drives Enterococcus prevalence, which in turn permit co-colonizing Gram-negative bacteria. Our results suggest biofilms in urinary catheters as a reservoir of pathogenic bacteria with the potential to develop and disseminate AMR.

【 授权许可】

Unknown   
Copyright © 2023 Karlsson, Pärssinen, Danielsson, Fatsis-Kavalopoulos, Frithiof, Hultström, Lipcsey, Järhult and Wang.