Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey
Abstract
:1. Introduction
2. Results
2.1. Distribution of Bacterial Isolates
2.2. Bacterial Resistance According to Specific Indicators
2.3. Bacterial Resistance to Specific Antibacterials
3. Discussion
Strengths and Limitations
4. Materials and Methods
4.1. Study Site, Data Collection and Management, Inclusion Criteria
4.2. Laboratory Procedures, Microbial Identification
4.3. Antimicrobial Susceptibility Testing
4.4. Definitions for the Classification of Resistance Groups
4.5. Statistical Analyses
4.6. Ethical Considerations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Data Availability
References
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Gram Stain | Bacterial Family/Genus/Species | Frequency (%) |
---|---|---|
Gram-positive n = 1032 (20.75%) | Enterococcus spp. | 471 (9.47%) |
Staphylococcus aureus | 561 (11.28%) | |
Gram-negative n = 3942 (79.25%) | Stenotrophomonas maltophilia | 4 (0.08%) |
Klebsiella spp. | 664 (13.35%) | |
Acinetobacter baumannii | 31 (0.62%) | |
Pseudomonas aeruginosa | 181 (3.64%) | |
Enterobacterales: Escherichia spp. | 2194 (44.11%) | |
Enterobacterales: Proteus spp. | 526 (10.57%) | |
Enterobacterales: Enterobacter spp. | 119 (2.39%) | |
Enterobacterales:Morganella spp. | 75 (1.51%) | |
Enterobacterales: Citrobacter spp. | 53 (1.07%) | |
Enterobacterales: Providencia spp. | 40 (0.8%) | |
Enterobacterales: Salmonella spp. | 33 (0.66%) | |
Enterobacterales: Serratia spp. | 22 (0.44%) | |
Total | 4974 (100%) |
Acro-nym | Bacterial Family/Genus/Species | Blood Culture (%) | Catheter-Specimen Urine (%) | Midstream Urine (%) | Wound or Abscess (%) | Others (%) | Total (%) |
---|---|---|---|---|---|---|---|
E | Enterococcus spp. | 93 (19.7%) | 191 (40.6%) | 76 (16.1%) | 48 (10.2%) | 63 (13.4%) | 471 (100%) |
S | Staphylococcus aureus | 252 (64.5%) | 12 (3.1%) | 6 (1.5%) | 121 (30.9%) | 0 (0%) | 391 (100%) |
Stenotrophomonas maltophilia | (0%) | 1 (0.6%) | (0%) | 3 (1.7%) | 170 (97.7%) | 174 (100%) | |
K | Klebsiella spp. | 212 (31.9%) | 234 (35.2%) | 118 (17.8%) | 49 (7.4%) | 51 (7.7%) | 664 (100%) |
A | Acinetobacter baumannii | 6 (19.4%) | 6 (19.4%) | (0%) | 5 (16.1%) | 14 (45.2%) | 31 (100%) |
P | Pseudomonas aeruginosa | 47 (26%) | 53 (29.3%) | 16 (8.8%) | 25 (13.8%) | 40 (22.1%) | 181 (100%) |
E | Enterobacterales: Citrobacter spp. | 13 (24.5%) | 17 (32.1%) | 7 (13.2%) | 9 (17%) | 7 (13.2%) | 53 (100%) |
Enterobacterales: Enterobacter spp. | 27 (22.7%) | 30 (25.2%) | 9 (7.6%) | 24 (20.2%) | 29 (24.4%) | 119 (100%) | |
Enterobacterales: Escherichia spp. | 676 (30.8%) | 823 (37.5%) | 531 (24.2%) | 75 (3.4%) | 89 (4.1%) | 2194 (100%) | |
Enterobacterales: Morganella morganii | 25 (33.3%) | 11 (14.7%) | 2 (2.7%) | 21 (28%) | 16 (21.3%) | 75 (100%) | |
Enterobacterales: Proteus spp. | 116 (22.1%) | 174 (33.1%) | 44 (8.4%) | 99 (18.8%) | 93 (17.7%) | 526 (100%) | |
Enterobacterales: Providencia spp. | 6 (15%) | 15 (37.5%) | 2 (5%) | 8 (20%) | 9 (22.5%) | 40 (100%) | |
Enterobacterales: Salmonella spp. | 29 (87.9%) | 3 (9.1%) | 1 (3%) | 0 (0%) | 0 (0%) | 33 (100%) | |
Enterobacterales: Serratia spp. | 5 (22.7%) | 1 (4.5%) | 2 (9.1%) | 7 (31.8%) | 7 (31.8%) | 22 (100%) | |
Total | 1507 (30.3%) | 1571 (31.6%) | 814 (16.4%) | 494 (9.9%) | 588 (11.8%) | 4974 (100%) |
Bacterial Family/Genus/Species | Isolates (100%) | Wt (%) | UDR (%) | MDR (%) | DTR (%) | XDR (%) |
---|---|---|---|---|---|---|
Enterococcus spp. | 471 | 18 (3.82%) | 0 (0%) | |||
Staphylococcus aureus | 561 | 110 (19.61%) | 0 (0%) | |||
Stenotrophomonas maltophilia | 4 | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | |
Klebsiella spp. | 664 | 390 (58.73%) | 274 (41.27%) | 182 (27.41%) | 1 (0.15%) | 0 (0%) |
Acinetobacter baumannii | 31 | 4 (12.90%) | 27 (87.10%) | 21 (67.74%) | 13 (41.94%) | 0 (0%) |
Pseudomonas aeruginosa | 181 | 117 (64.64%) | 64 (35.36%) | 24 (13.26%) | 8 (4.42%) | 1 (0.55%) |
Citrobacter spp. | 53 | 38 (71.70%) | 15 (28.30%) | 6 (11.32%) | 0 (0%) | 0 (0%) |
Enterobacter spp. | 119 | 79 (66.39%) | 40 (33.61%) | 14 (11.76%) | 0 (0%) | 0 (0%) |
Escherichia spp. | 2194 | 891 (40.61%) | 1303 (59.39%) | 572 (26.07%) | 0 (0%) | 0 (0%) |
Morganellas spp. | 75 | 12 (16%) | 63 (84.00%) | 14 (18.67%) | 0 (0%) | 0 (0%) |
Proteus spp. | 526 | 129 (24.52%) | 397 (75.48%) | 214 (40.68%) | 1 (0.19%) | 0 (0%) |
Providencia spp. | 40 | 14 (35%) | 26 (65.00%) | 5 (12.50%) | 0 (0%) | 0 (0%) |
Salmonella spp. | 33 | 28 (84.85%) | 5 (15.15%) | 0 (0%) | 0 (0%) | 0 (0%) |
Serratia spp. | 22 | 13 (59.09%) | 9 (40.91%) | 3 (13.64%) | 0 (0%) | 0 (0%) |
Total | 4974 | 2751 (55.31%) | 2223 (44.69%) | 1183 (23.78%) | 23 (0.46%) | 1 (0.02%) |
OXA | AMP | CC | CIP * | ERY | GM | LNZ | TEC | VA | TGC | SXT | MDR | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Enterococcus faecalis | IR | 100.0 | IR | 56.8 | IR | IR | 99.1 | 100.0 | 100.0 | 99.3 | IR | 0.7 |
Enterococcus faecium | IR | IR | IR | 7.1 | IR | IR | 100.0 | 78.8 | 66.7 | 100.0 | IR | 45.5 |
Staphylococcus aureus | 83.1 | IR | 79.4 | 80.7 | 78.0 | 98.6 | 100.0 | 100.0 | 100.0 | 100.0 | 98.6 | 19.6 |
MSSA | - | IR | 89.2 | 92.8 | 88.2 | 99.4 | 100.0 | 99.8 | 100.0 | 100.0 | 98.7 | 3.2 |
MRSA | - | IR | 30.9 | 22.1 | 27.7 | 94.7 | 100.0 | 100.0 | 100.0 | 100.0 | 97.9 | 100.0 |
AMP | AMC | CXM | CTX | CAX | CAZ | FEP | TZP | ETP | MEM | CIP | AK | GM | SXT | MDR | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Klebsiella aerogenes | 0.0 | IR | 66.7 | 75.0 | 80.6 | 80.6 | 85.7 | 80.0 | 100.0 | 100.0 | 87.1 | 100.0 | 96.8 | 93.5 | 22.6 |
Klebsiella oxytoca | 0.0 | 91.1 | 96.8 | 98.0 | 97.5 | 97.5 | 98.0 | 98.0 | 100.0 | 100.0 | 100.0 | 98.0 | 100.0 | 98.7 | 2.53 |
Klebsiella pneumoniae | 0.0 | 67.5 | 67.2 | 73.0 | 69.4 | 69.4 | 76.6 | 76.1 | 99.8 | 99.8 | 62.8 | 79.3 | 79.1 | 65.5 | 32.6 |
Klebsiella variicola | 0.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 0.0 |
Acinetobacter baumannii | NT | IR | NT | NT | IR | NT | NT | NT | IR | 55.2 | 13.8 | 37.9 | 40.7 | 21.4 | 65.5 |
Pseudomonas aeruginosa | NT | IR | NT | NT | IR | 90.6 | 91.7 | 87.2 | IR | 85.6 | 77.9 | 96.7 | 90.1 | NT | 13.3 |
Citrobacter freundii | 0.0 | IR | 20.0 | 82.4 | 71.4 | 71.4 | 82.4 | 82.4 | 100.0 | 100.0 | 90.5 | 100.0 | 100.0 | 100.0 | 19 |
Citrobacter koseri | 0.0 | 81.5 | 77.3 | 100.0 | 100.0 | 100.0 | 100.0 | 85.7 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 3.7 |
Enterobacter cloacae | 0.0 | IR | 38.8 | 84.4 | 83.0 | 83.0 | 84.4 | 84.1 | 100.0 | 100.0 | 93.3 | 98.4 | 98.9 | 93.2 | 11.2 |
Escherichia coli | 48.5 | 81.8 | 85.4 | 85.8 | 86.1 | 86.2 | 86.7 | 85.0 | 100.0 | 100.0 | 67.9 | 89.2 | 90.3 | 72.7 | 26.1 |
Morganella morganii | 0.0 | IR | 0.0 | 93.3 | 90.3 | 90.3 | 93.3 | 90.0 | 100.0 | 100.0 | 90.3 | 91.5 | 91.7 | 72.2 | 18.1 |
Proteus mirabilis | 40.4 | 62.3 | 63.0 | 71.7 | 69.1 | 69.1 | 75.5 | 74.7 | 99.8 | 100.0 | 57.7 | 75.7 | 77.2 | 32.1 | 42.7 |
Proteus vulgaris | 0.0 | 40.0 | 0.0 | 95.5 | 91.4 | 91.4 | 95.5 | 95.5 | 100.0 | 100.0 | 85.7 | 95.5 | 91.4 | 65.7 | 14.3 |
Providencia stuartii | 0.0 | IR | 31.6 | 93.3 | 96.6 | 96.6 | 92.9 | 92.9 | 100.0 | 100.0 | 72.4 | 36.4 | 28.6 | 29.6 | 17.2 |
Salmonella spp. | 90.6 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 96.0 | 100.0 | 100.0 | 96.9 | 0.0 |
Enterobacterales | 34.6 | 70.4 | 76.0 | 83.1 | 82.3 | 82.3 | 84.9 | 83.5 | 99.9 | 100.0 | 69.4 | 86.1 | 87.5 | 68.5 | 27.1 |
Enterobacterales non ESBL | 100.0 | 100.0 | 82.2 | 93.5 | 93.8 | 77.1 | 11.8 | ||||||||
Enterobacterales ESBL | 99.7 | 99.8 | 9.6 | 46.8 | 58.6 | 27.9 | 98.5 |
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Benkő, R.; Gajdács, M.; Matuz, M.; Bodó, G.; Lázár, A.; Hajdú, E.; Papfalvi, E.; Hannauer, P.; Erdélyi, P.; Pető, Z. Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey. Antibiotics 2020, 9, 624. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9090624
Benkő R, Gajdács M, Matuz M, Bodó G, Lázár A, Hajdú E, Papfalvi E, Hannauer P, Erdélyi P, Pető Z. Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey. Antibiotics. 2020; 9(9):624. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9090624
Chicago/Turabian StyleBenkő, Ria, Márió Gajdács, Mária Matuz, Gabriella Bodó, Andrea Lázár, Edit Hajdú, Erika Papfalvi, Peter Hannauer, Péter Erdélyi, and Zoltán Pető. 2020. "Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey" Antibiotics 9, no. 9: 624. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics9090624