Pathogen distribution and microbial resistance pattern in endotracheal aspirate samples of intensive care unit patients before and after the COVID-19 pandemic

Year 2023, , 1185 - 1192, 29.10.2023

Hülya Duran , Nuri Kiraz , Zülal Zeynep Utkulu , Berna Erdal , Yavuz Uyar

https://doi.org/10.32322/jhsm.1345530

Abstract

Aims: The aim of this study is to evaluate the distribution of pathogen microorganisms and antimicrobial resistance rates isolated from endotracheal aspirate (ETA) samples of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction (PCR) positive and negative patients followed and treated in the intensive care unit (ICU) of our hospital, and to examine the effect of the COVID-19 (coronavirus disease 2019) pandemic on this.
Methods: In this study, ETA samples sent to the microbiology laboratory from hospitalized patients in Tekirdağ Namık Kemal University Hospital general ICU-1 and general ICU-2 between March 11, 2018 and March 10, 2022 were retrospectively analyzed. During the COVID-19 pandemic, it was used to follow up patients with SARS-CoV-2 PCR positive in ICU-1 and SARS-CoV-2 PCR negative patients in ICU-2. The working period is divided into two parts as pre-pandemic (2018 - 2019) and post-pandemic (2020 - 2021). Bacterial identification and antibiotic susceptibility tests were performed using conventional methods and automated systems. Colistin sensitivity was studied by broth microdilution, and ceftazidime avibactam (CZA) sensitivity was studied by disk diffusion method. Statistical analysis was performed with the chi-square test, p<0.05 was considered significant.
Results: A total of 1669 ETA samples from 856 patients were sent to our laboratory over a four-years period, and culture positivity was detected in 63.6% of the samples. With the COVID-19 pandemic, it was found that the culture positivity increased significantly in ETA samples of patients hospitalized in ICU-1, and there were no significant difference in ICU-2. 836 isolates from 1061 specimens were included to the study. The three most commonly isolated pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, respectively. While P. aeruginosa was the most frequently isolated microorganism in both ICU-1 and ICU-2 in the pre-pandemic period, it was replaced by A. baumannii in both clinics with the pandemic, and the increase in the frequency of A. baumannii in ICU-1 was statistically significant. Antibiotic resistance rates were generally found to be higher in ICU-1 than in ICU-2, and even in ICU-2, resistance rates to some antimicrobials were found to be decreased. In A. baumannii, a statistically significant increase was observed in the resistance rates against all antibiotics, including colistin, in ICU-1, and a significant increase was found in resistance only against amikacin in ICU-2. In P. aeruginosa, a significant increase was found in the resistance rates against cephalosporins and carbapenems in ICU-1, ceftazidime, ciprofloxacin and colistin in ICU-2, and a significant decrease in resistance to amikacin in ICU-2. In K. pneumoniae, a significant increase was found in the resistance rates against amoxicillin-clavulanate (AMC), ceftriaxone, ertapenem, amikacin and colistin in ICU-1, ertapenem and amikacin in ICU-2, and a significant decrease in resistance to AMC and all cephalosporins in ICU-2. CZA susceptibility in K. pneumoniae isolates was examined in 2020 and 2021, and no resistance was found in either clinic.
Conclusion: In our study, it was determined that the culture positivity rate in ETA samples increased, the distribution of pathogen microorganisms and antimicrobial resistance rates changed with the COVID-19 pandemic. For this reason, it is important to follow up possible pathogen microorganisms and antimicrobial resistance rates during similar pandemic periods such as COVID-19.

Keywords

antimicrobial resistance, COVID-19, endotracheal aspirate, pathogen microorganism

Project Number

yok

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