Butscheid Yulia, Frey Pascal M, Pfister Marc, Pagani Lisa, Kouyos Roger D, Scheier Thomas C, Staiger Willy I, Mancini Stefano, Brugger Silvio D
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
J Antimicrob Chemother. 2025 Jul 1;80(7):1837-1848. doi: 10.1093/jac/dkaf136.
Understanding the effects of changes brought by the COVID-19 pandemic on antimicrobial resistance in P. aeruginosa (PA) is essential to inform clinical management.
This single-centre retrospective cohort study included adult inpatients with PA bacteraemia at the University Hospital Zurich between January 2014 and December 2023. The primary outcome was the association between the start of the COVID-19 pandemic and PA with multidrug resistance (MDR), defined as resistance to ≥3 of 5 antibiotic classes. We used logistic regression to adjust for age, sex and ICU treatment. Secondary outcomes included changes in resistance patterns, patient demographics and antimicrobial consumption.
A total of 493 instances of PA bacteraemia in 333 patients were observed during the study period. The proportion of MDRPA declined from 21% (62/291) pre-pandemic to 9% (19/202) post-pandemic (adjusted OR 0.38, 95% CI 0.18-0.79, p = 0.01). The occurrence of MDRPA during hospitalization following an initial instance of non-MDRPA bacteraemia was rare and unlikely to happen earlier than after 2 weeks. After the start of the pandemic, we observed no MDRPA cases involving cardiovascular or pulmonary diseases and marked reductions in patients with burn injuries or organ transplants. Furthermore, ciprofloxacin and tobramycin use significantly decreased after the start of the pandemic. Overall in-hospital mortality among patients with MDRPA bacteraemia remained high (28%), with no substantial differences between time periods.
We observed a decline in MDRPA occurrence after the start of the COVID-19 pandemic, possibly driven by intensified infection control measures, shifts in antimicrobial use and changes in patient populations.
了解2019冠状病毒病大流行带来的变化对铜绿假单胞菌（PA）耐药性的影响对于指导临床管理至关重要。
这项单中心回顾性队列研究纳入了2014年1月至2023年12月期间苏黎世大学医院成年PA菌血症住院患者。主要结局是2019冠状病毒病大流行开始与具有多重耐药性（MDR）的PA之间的关联，MDR定义为对5类抗生素中的≥3类耐药。我们使用逻辑回归对年龄、性别和重症监护病房治疗进行校正。次要结局包括耐药模式变化、患者人口统计学特征和抗菌药物使用情况。
在研究期间共观察到333例患者发生493次PA菌血症。MDRPA的比例从大流行前的21%（62/291）降至大流行后的9%（19/202）（校正比值比0.38，95%置信区间0.18 - 0.79，p = 0.01）。在首次发生非MDRPA菌血症后的住院期间发生MDRPA的情况很少见，且不太可能早于2周后发生。大流行开始后，我们未观察到涉及心血管或肺部疾病的MDRPA病例，烧伤或器官移植患者显著减少。此外，大流行开始后环丙沙星和妥布霉素的使用显著减少。MDRPA菌血症患者的总体院内死亡率仍然很高（28%），不同时间段之间无实质性差异。
我们观察到2019冠状病毒病大流行开始后MDRPA的发生率有所下降，这可能是由于强化感染控制措施、抗菌药物使用的变化和患者群体的改变所致。
