PDF(Pubmed)
Abstract：
BACKGROUND: Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum β-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen.
METHODS: Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex.
RESULTS: The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years.
CONCLUSIONS: The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.
METHODS: Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex.
RESULTS: The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years.
CONCLUSIONS: The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.
摘要：
背景：在COVID-19大流行之前，大肠杆菌的抗菌素耐药性（AMR）不断增加，尿路感染和血流感染的最常见原因。这项研究的目的是调查COVID-19大流行对芬兰尿液和血液大肠杆菌分离株中超广谱β-内酰胺酶（ESBL）产生的影响，以提高我们对这种主要多药耐药病原体的来源归属的认识。
方法：从芬兰临床微生物学实验室的全国监测数据库中获得了564,233例尿液（88.3%来自女性）和23,860例血液大肠杆菌（58.8%来自女性）的药敏试验结果。根据EUCAST指南进行药敏试验。我们比较了产ESBL大肠杆菌的比例和发病率（2018-2019年），在（2020-2021年）期间，在(2022年)大流行之后，按年龄组和性别对这些疾病进行了分层。
结果：在2018-2022年期间，经抗菌素敏感性测试的尿液大肠杆菌分离株的年度数量减少了23.3％，而血液大肠杆菌分离株的数量增加了1.1％。男性尿液大肠杆菌分离株中产生ESBL的大肠杆菌的年比例下降了28.7%，从6.9%（2018-2019年平均）到2022年的4.9%，女性为28.7%，从3.0到2.1%。在血液大肠杆菌分离物中，男性比例下降32.9%，从9.3%到6.2%，女性占26.6%，从6.2%到4.6%。在大多数年龄组中也观察到了显着的下降趋势，但年龄≥60岁人群的风险仍然最高.
结论：产ESBL大肠杆菌比例的降低是全面的，涵盖两种样本类型，两性,和所有年龄组，表明持续增长的趋势可以逆转。国际旅行和抗菌药物使用的减少可能是这一减少的背后，建议告知旅行者耐多药细菌的风险，卫生措施,和适当的抗菌药物的使用是至关重要的预防。评估医疗机构中的感染控制措施可能是有益的，尤其是长期护理。
方法：从芬兰临床微生物学实验室的全国监测数据库中获得了564,233例尿液（88.3%来自女性）和23,860例血液大肠杆菌（58.8%来自女性）的药敏试验结果。根据EUCAST指南进行药敏试验。我们比较了产ESBL大肠杆菌的比例和发病率（2018-2019年），在（2020-2021年）期间，在(2022年)大流行之后，按年龄组和性别对这些疾病进行了分层。
结果：在2018-2022年期间，经抗菌素敏感性测试的尿液大肠杆菌分离株的年度数量减少了23.3％，而血液大肠杆菌分离株的数量增加了1.1％。男性尿液大肠杆菌分离株中产生ESBL的大肠杆菌的年比例下降了28.7%，从6.9%（2018-2019年平均）到2022年的4.9%，女性为28.7%，从3.0到2.1%。在血液大肠杆菌分离物中，男性比例下降32.9%，从9.3%到6.2%，女性占26.6%，从6.2%到4.6%。在大多数年龄组中也观察到了显着的下降趋势，但年龄≥60岁人群的风险仍然最高.
结论：产ESBL大肠杆菌比例的降低是全面的，涵盖两种样本类型，两性,和所有年龄组，表明持续增长的趋势可以逆转。国际旅行和抗菌药物使用的减少可能是这一减少的背后，建议告知旅行者耐多药细菌的风险，卫生措施,和适当的抗菌药物的使用是至关重要的预防。评估医疗机构中的感染控制措施可能是有益的，尤其是长期护理。
