Epidemiology and antimicrobial susceptibility profiles of Enterobacterales causing bloodstream infections before and during COVID-19 pandemic: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) in Taiwan, 2018-2021

Yu-Lin Lee; Chun-Eng Liu; Hung-Jen Tang; Yu-Tsung Huang; Yao-Shen Chen; Po-Ren Hsueh; SMART Taiwan Group

doi:10.1016/j.jmii.2024.04.004

Epidemiology and antimicrobial susceptibility profiles of Enterobacterales causing bloodstream infections before and during COVID-19 pandemic: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) in Taiwan, 2018-2021

J Microbiol Immunol Infect. 2024 Apr 7:S1684-1182(24)00072-0. doi: 10.1016/j.jmii.2024.04.004. Online ahead of print.

Authors

Yu-Lin Lee¹, Chun-Eng Liu², Hung-Jen Tang³, Yu-Tsung Huang⁴, Yao-Shen Chen⁵, Po-Ren Hsueh⁶; SMART Taiwan Group

Collaborators

SMART Taiwan Group:
Wen-Chien Ko, Po-Liang Lu, Chun-Eng Liu, Kenneth Yin-Ching Chuang, Fu-Der Wang, Yao-Shen Chen, Min-Chi Lu, Mao-Wang Ho

Affiliations

¹ Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Ph.D Program in Medical Biotechnology, National Chung-Hsing University, Taichung, Taiwan.
² Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
³ Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁴ Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
⁵ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁶ Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Ph.D Program for Ageing, School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@gmail.com.

PMID: 38632023
DOI: 10.1016/j.jmii.2024.04.004

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has contributed to the spread of antimicrobial resistance, including carbapenem-resistant Enterobacterales.

Methods: This study utilized data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program in Taiwan. Enterobacterales from patients with bloodstream infections (BSIs) were collected and subjected to antimicrobial susceptibility testing and β-lactamase gene detection using a multiplex PCR assay. Statistical analysis was conducted to compare susceptibility rates and resistance genes between time periods before (2018-2019) and during the COVID-19 pandemic (2020-2021).

Results: A total of 1231 Enterobacterales isolates were collected, predominantly Escherichia coli (55.6%) and Klebsiella pneumoniae (29.2%). The proportion of nosocomial BSIs increased during the COVID-19 pandemic (55.5% vs. 61.7%, p < 0.05). Overall, susceptibility rates for most antimicrobial agents decreased, with Enterobacterales from nosocomial BSIs showing significantly lower susceptibility rates than those from community-acquired BSIs. Among 123 Enterobacterales isolates that underwent molecular resistance mechanism detection, ESBL, AmpC β-lactamase, and carbapenemase genes were detected in 43.1%, 48.8% and 16.3% of the tested isolates, respectively. The prevalence of carbapenemase genes among carbapenem-resistant Enterobacterales increased during the pandemic, although the difference was not statistically significant. Two novel β-lactamase inhibitor combinations, imipenem-relebactam and meropenem-vaborbactam, preserved good efficacy against Enterobacterales. However, imipenem-relebactam showed lower in vitro activity against imipenem-non-susceptible Enterobacterales than that of meropenem-vaborbactam.

Conclusions: The COVID-19 pandemic appears to be associated with a general decrease in antimicrobial susceptibility rates among Enterobacterales causing BSIs in Taiwan. Continuous surveillance is crucial to monitor antimicrobial resistance during the pandemic and in the future.

Keywords: COVID-19; Carbapenem resistance; Enterobacterales; Imipenem-relebactam; Meropenem-vaborbactam; Multidrug resistance.