| Abstract |
Background
Antimicrobial resistance (AMR) has now emerged as a chronic public health problem globally. In July 2022, the Commission and the Member States, identified AMR as one of the top three priority health threats. AMR affects countries, in all regions and at all income levels.
Objective
This study aimed to investigate the characteristics and changes in resistance of microbes from the cultures obtained in the Emergency Department of a tertiary hospital in Greece from 2018 to 2022. We also aimed to recognize the local antimicrobial resistance characteristics in order to adjust empirical therapy in the ED.
Methods
We performed a monocentric retrospective observational study. From 2018 to 2022, we analyzed all culture samples obtained from the ΕD of a tertiary hospital in Crete. All data were collected from the microbiology laboratory through the WHONET network.
Results
Urine cultures: from the total number of urine cultures obtained, 6.180 were positive. The most common microorganisms isolated depended on the patients’ age. In the age group above 35 years old, the most common microbes were E. coli (53.47%), K. pneumoniae (11.63%), P. mirabilis (7.28%), E. faecalis (4.84%), and P. aeruginosa (3.97%). In the age group above 35 years old, the most common microbes were E. coli (63.23%), St. Saprophyticus (10.30%), P. mirabilis (7.98%), K. pneumoniae (6.48%), E. faecalis (3.54%). For E. coli statistically significant variation in the antimicrobial resistance, during the period analyzed, was observed in two antibiotics: amoxicillin/clavulanic acid and nitrofurantoin. E. coli isolates displayed less than 8% resistance to piperacillin/tazobactam, amikacin, carbapenems, fosfomycin, and nitrofurantoin (except for 2018 for nitrofurantoin). E. coli isolates from these two distinct groups displayed statistically significant differences in their resistance to most antibiotics, including amoxicillin/clavulanic acid, piperacillin/tazobactam, 2nd and 3rd generation cephalosporins, quinolones, amikacin, and trimethoprim/sulfamethoxazole. Klebsiela pneumoniae emerged as the microorganism with the highest antimicrobial resistance in most common antibiotics. K. pneumoniae had the lowest resistance in carbapenems (7,61%-16,11%), followed by amikacin (15,06%-23,33%). Statistically significant variation in the antimicrobial resistance of K. Pneumoniae was observed during the study period for piperacillin/tazobactam and amikacin. For P. mirabilis, a statistically significant variation in antimicrobial resistance was observed in piperacillin/tazobactam, amikacin, and carbapenems. P. mirabilis had the lowest resistance to piperacillin/tazobactam, amikacin, and carbapenems. For P. mirabilis, statistically significant variation in the antimicrobial resistance between the two age groups was observed in amoxicillin/clavulanic acid, piperacillin/tazobactam, 2nd and 3rd generation cephalosporins, quinolones, amikacin, and trimethoprim/sulfamethoxazole. Stool cultures: the most common microorganisms isolated were Campylobacter spp (60.08%), Salmonella spp (23.24), C. difficile (11.4), and E. coli (2.19%). Extremely high resistance to ciprofloxacin was observed in Campylobacter spp, while resistance to macrolides was less than 5% during the study period. Salmonella spp instead showed high sensitivity in quinolones. We had no data on Salmonella spp resistance to macrolides.
Conclusion
Regarding urinary tract infections, we observed high resistance to most prescribed antibiotics, especially in elderly patients. This raises the question of whether continuing to treat these patients according to the current guidelines is effective. Regarding bacterial gastroenteritis, Campylobacter spp. quinolone-resistance and macrolide sensitivity suggest that a paradigm shift in the treatment of bacterial gastroenteritis is needed.
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