Distribution of pathogens and antimicrobial resistance in bacteraemia according to hospitalization duration: a nationwide surveillance study in Switzerland

Niccolò Buetti; Jonas Marschall; Jean-François Timsit; Andrew Atkinson; Andreas Kronenberg; Rami Sommerstein; Swiss Centre for Antibiotic Resistance (ANRESIS)

doi:10.1016/j.cmi.2021.04.025

Distribution of pathogens and antimicrobial resistance in bacteraemia according to hospitalization duration: a nationwide surveillance study in Switzerland

Clin Microbiol Infect. 2021 Dec;27(12):1820-1825. doi: 10.1016/j.cmi.2021.04.025. Epub 2021 Apr 30.

Authors

Niccolò Buetti¹, Jonas Marschall², Jean-François Timsit³, Andrew Atkinson², Andreas Kronenberg⁴, Rami Sommerstein⁵; Swiss Centre for Antibiotic Resistance (ANRESIS)

Collaborators

Swiss Centre for Antibiotic Resistance (ANRESIS):
A Burnens⁶, A Cherkaoui⁷, C Corradi⁸, O Dubuis⁹, A G Viollier⁹, A Egli¹⁰, V Gaia¹¹, D Koch⁸, A Kronenberg¹², S L Leib¹², J Marschall¹³, P Nordmann¹⁴, V Perreten¹⁵, J-C Piffaretti¹⁶, G Prod'hom¹⁷, J Schrenzel¹⁸, A F Widmer¹⁹, G Zanetti²⁰, R Zbinden²¹

Affiliations

¹ Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: niccolo.buetti@gmail.com.
² Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland.
³ UMR 1137-IAME Team 5-DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
⁴ Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
⁵ Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; Infectious Diseases and Hospital Epidemiology, Hirslanden Central Switzerland, Lucerne, Switzerland.
⁶ Synlab Suisse, Switzerland.
⁷ Bacteriology Laboratory, Geneva University Hospitals, Switzerland.
⁸ Federal Office of Public Health, Bern, Switzerland.
⁹ Basel, Switzerland.
¹⁰ Clinical Microbiology, University Hospital Basel, Switzerland.
¹¹ Department of Microbiology, EOLAB, Bellinzona, Switzerland.
¹² Institute for Infectious Diseases, University of Bern, Switzerland.
¹³ Department of Infectious Diseases, University Hospital, Bern, Switzerland.
¹⁴ Molecular and Medical Microbiology, Department of Medicine, University Fribourg, Switzerland.
¹⁵ Institute of Veterinary Bacteriology, University of Bern, Switzerland.
¹⁶ Interlifescience, Massagno, Switzerland.
¹⁷ Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
¹⁸ Bacteriology Laboratory, Geneva University Hospitals, Geneva, Switzerland.
¹⁹ Division of Infectious Diseases & Hospital Epidemiology, University of Basel, Switzerland.
²⁰ Service of Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
²¹ Institute of Medical Microbiology, University of Zürich, Switzerland.

PMID: 33933567
DOI: 10.1016/j.cmi.2021.04.025

Abstract

Objectives: Changing microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteraemia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland.

Methods: We conducted a nationwide, observational study on bacteraemia using ANRESIS data from 1 January 2008 to 31 December 2017. We analysed data on bacteraemia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during hospitalization for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens and Staphylococcus aureus.

Results: We included 28 318 bacteraemia isolates from 90 Swiss hospitals. The most common aetiology was E. coli (33.4%, 9459), followed by S. aureus (16.7%, 4721), K. pneumoniae (7.1%, 2005), Enterococcus faecalis (5.2%, 1473), P. aeruginosa (4.3%, 1228), Streptococcus pneumoniae (4.3%, 1208) and Enterococcus faecium (3.9%, 1101). We observed 489 (1.73%) S. marcescens isolates. We observed an increasing trend for E. faecium (from 1.5% at day 0 to 13.7% at day 30; p < 0.001), K. pneumoniae (from 6.1% to 7.8%, p < 0.001) and P. aeruginosa (from 2.9% to 13.7%, p < 0.001) with increasing duration of hospitalization; and decreasing trends for E. coli (from 41.6% to 21.6%; p < 0.001) and S. aureus (p < 0.001). Ceftriaxone resistance among E. coli remained stable for the first 15 days of hospitalization and then increased. Ceftriaxone resistance among K. pneumoniae and S. marcescens and oxacillin resistance among S. aureus increased linearly during the hospitalization. Cefepime resistance among P. aeruginosa remained stable during the hospitalization.

Discussion: We showed that hospitalization duration is associated with a species- and antibiotic class-dependent pattern of antimicrobial resistance.

Keywords: Bacteraemia; Bloodstream infection; Hospitalization duration; Length of stay; Microorganism; Resistance.

Publication types

Observational Study

MeSH terms

Anti-Bacterial Agents* / pharmacology
Bacteremia* / drug therapy
Bacteremia* / epidemiology
Ceftriaxone
Drug Resistance, Bacterial*
Hospitalization
Humans
Length of Stay*
Microbial Sensitivity Tests
Switzerland / epidemiology

Substances

Anti-Bacterial Agents
Ceftriaxone