Distribution of pathogens and antimicrobial resistance in bacteremia according to hospitalization duration: A nationwide surveillance study in Switzerland.

Buetti, Niccolò; Marschall, Jonas; Timsit, Jean-François; Atkinson, Andrew; Kronenberg, Andreas; Sommerstein, Rami (2021). Distribution of pathogens and antimicrobial resistance in bacteremia according to hospitalization duration: A nationwide surveillance study in Switzerland. Clinical microbiology and infection, 27(12), pp. 1820-1825. Elsevier 10.1016/j.cmi.2021.04.025

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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 bacteremia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland.

METHODS

We conducted a nationwide, observational study on bacteremia using ANRESIS data from 1st January 2008 to 31st December 2017. We analyzed data on bacteremia 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 the hospitalization for E. coli, K. pneumoniae, P. aeruginosa, S. marcescens and S. aureus.

RESULTS

We included 28,318 bacteremia isolates from 90 Swiss hospitals. The most common etiology was E. coli (33.4%, 9,459), followed by S. aureus (16.7%, 4,721), K. pneumoniae (7.1%, 2,005), E. faecalis (5.2%, 1,473), P. aeruginosa (4.3%, 1,228), S. pneumoniae (4.3%, 1,208) and E. faecium (3.9%, 1,101). We observed 489 (1.73%) Serratia marcescens isolates. We observed an increasing trend for Enterococcus 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 a decreasing trends for E. coli (from 41.6% at day 0 to 21.6% at day 30; p<0.001) and S. aureus (from 14.4% to 14.7%; 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.

CONCLUSIONS

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

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