Evolution of Antimicrobial Resistance in Community vs. Hospital-Acquired Infections
Abstract
Introduction
Hospitals are high-risk environments for infections. Despite the global recognition of these pathogens, few studies compare microorganisms from community-acquired and hospital-acquired infections (HAIs). This study compares these microorganisms and explores their relationship with patients' comorbidities and socio-demographic factors.
Methods
This retrospective cross-sectional study was conducted at Smart Health Tower, Iraq, from January to December 2023, focusing on patients with community-acquired infections and HAIs. Data were extracted from microbiology laboratory records, including blood cultures, urine samples, and other body fluids, with patients classified based on CDC and IDSA guidelines. Bacterial identification combined conventional methods and the BD Phoenix™ M50 system, while antibiotic susceptibility was tested using the Kirby-Bauer method and the same automated system. Statistical analysis of resistance patterns utilized SPSS version 25, with significance set at p ≤ 0.05.
Results
In this study of 2,157 participants, 1,303 (60.4%) were male, with microbial growth observed in 1,177 cases (54.6%). Notably, 41.1% of females and 52.1% of males showed no growth (p < 0.001). The mean age was 43.62 ± 23.3 years. Wound samples had the highest growth rate (91.2%), while body fluids had the lowest (33.0%) (p < 0.001). The overall multidrug resistance rates were 62.5% for community-acquired infections and 79.3% for HAIs. Patients with pre-existing comorbidities demonstrated significantly higher rates of hospital-acquired infections (p < 0.05).
Conclusion
Multidrug-resistant isolates are more prevalent in HAIs than in community-acquired infections, highlighting the need for enhanced surveillance to optimize antibiotic use and control HAIs through early detection of resistance.
References
- Matta R, Hallit S, Hallit R, Bawab W, Rogues AM, Salameh P. Epidemiology and microbiological profile comparison between community and hospital acquired infections: a multicenter retrospective study in Lebanon. Journal of infection and public health. 2018;11(3):405-11.doi:10.1016/j.jiph.2017.09.005
- Chen Y, Xu X, Liang J, Lin H. Relationship between climate conditions and nosocomial infection rates. African Health Sciences. 2013;13(2):339-43. doi:10.4314/ahs.v13i2.20
- Alp E, Leblebicioglu H, Doganay M, Voss A. Infection control practice in countries with limited resources. Annals of clinical microbiology and antimicrobials. 2011; 10:1-4. doi:10.1186/1476-0711-10-36
- Cornejo-Juárez P, Vilar-Compte D, Pérez-Jiménez C, Ñamendys-Silva SA, Sandoval-Hernández S, Volkow-Fernández P. The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit. International Journal of Infectious Diseases. 2015; 31:31-4. doi:10.1016/j.ijid.2014.12.022
- Rosenthal VD, Belkebir S, Zand F, Afeef M, Tanzi VL, Al-Abdely HM, et al. Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 246 intensive units of 83 hospitals in 52 cities of 14 countries of Middle East: Bahrain, Egypt, Iran, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Pakistan, Palestine, Sudan, Tunisia, Turkey, and United Arab Emirates—International Nosocomial Infection Control Consortium (INICC) findings. Journal of infection and public health. 2020;13(8):1134-41. doi:10.1016/j.jiph.2020.03.012
- Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, Abdollahi B, Seyghalani Talab F, Sanaei M, Zarabi F, Dolati Y. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One. 2023;18(1):e0274248. doi:10.1371/journal.pone.0274248
- Gugliotta C, Deiana G, Dettori M, Sotgiu G, Azara A, Castiglia P. Prevalence study on health-care associated infections and on the use of antimicrobials carried out with the light protocol of the European Centre for Disease Prevention and Control. Ann Ig. 2020;32(4):357-67. doi:10.7416/ai.2020.2359
- Berglund Kristiansson E, Källman U. Healthcare staff's views on the patients' prerequisites to be co‐creator in preventing healthcare‐associated infections. Scandinavian journal of caring sciences. 2020;34(2):314-21. doi:10.1111/scs.12730
- Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control. 2008;36(5):309-32. doi:10.1016/j.ajic.2008.03.002
- Hong JS, Kim D, Kang DY, Park BY, Yang S, Yoon EJ, et al. Evaluation of the BD Phoenix M50 automated microbiology system for antimicrobial susceptibility testing with clinical isolates in Korea. Microbial Drug Resistance. 2019;25(8):1142-8. doi:10.1089/mdr.2018.0370
- Weinstein MP, Lewis JS. The clinical and laboratory standards institute subcommittee on antimicrobial susceptibility testing: background, organization, functions, and processes. Journal of clinical microbiology. 2020;58(3):10-128. doi:10.1128/jcm.01864-19
- Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection. 2012;18(3): 268-81. doi:10.1111/j.1469-0691.2011.03570.x
- Ahmed SK, Hussein S, Qurbani K, Ibrahim RH, Fareeq A, Mahmood KA, et al. Antimicrobial resistance: impacts, challenges, and future prospects. Journal of Medicine, Surgery, and Public Health. 2024; 2:100081. doi:10.1016/j.glmedi.2024.100081
- Majumder MA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, et al. Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health. Infection and drug resistance. 2020:4713-38. doi:10.2147/IDR.S290835
- Abban MK, Ayerakwa EA, Mosi L, Isawumi A. The burden of hospital acquired infections and antimicrobial resistance. Heliyon. 2023. doi:10.1016/j.heliyon.2023.e20561
- Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. New England Journal of Medicine. 2010;362(19):1804-13. doi:10.1056/NEJMra0904124
- Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. Jama. 2009;302(21):2323-9. doi:10.1001/jama.2009.1754
- World Health Organization. Antimicrobial resistance: global report on surveillance. World Health Organization; 2014. https://iris.who.int/bitstream/handle/10665/112642/?sequence=1
- Saleem Z, Godman B, Hassali MA, Hashmi FK, Azhar F, Rehman IU. Point prevalence surveys of health-care-associated infections: a systematic review. Pathogens and global health. 2019;113(4):191-205. doi:10.1080/20477724.2019.1632070
- Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence. 2013;4(2):107-18. doi:10.4161/viru.22718
- Flores-Valdez M, Ares MA, Rosales-Reyes R, Torres J, Girón JA, Weimer BC, et al. Whole genome sequencing of pediatric Klebsiella pneumoniae strains reveals important insights into their virulence-associated traits. Frontiers in Microbiology. 2021; 12:711577. doi:10.3389/fmicb.2021.711577
- Su S, Zhang J, Zhao Y, Yu L, Wang Y, Wang Y, et al. Outbreak of KPC-2 Carbapenem-resistant Klebsiella pneumoniae ST76 and Carbapenem-resistant K2 Hypervirulent Klebsiella pneumoniae ST375 strains in Northeast China: molecular and virulent characteristics. BMC Infectious Diseases. 2020; 20:1-4. doi:10.1186/s12879-020-05143-y
- Menon RU, George AP, Menon UK. Etiology and anti-microbial sensitivity of organisms causing community acquired pneumonia: a single hospital study. Journal of family medicine and primary care. 2013;2(3):244-9. doi:10.4103/2249-4863.120728
- Wang M, Wei H, Zhao Y, Shang L, Di L, Lyu C, et al. Analysis of multidrug-resistant bacteria in 3223 patients with hospital-acquired infections (HAI) from a tertiary general hospital in China. Bosnian journal of basic medical sciences. 2019;19(1):86. doi:10.17305/bjbms.2018.3826
- Otto M. Community-associated MRSA: what makes them special?. International Journal of Medical Microbiology. 2013;303(6-7):324-30. doi:10.1016/j.ijmm.2013.02.007
- Cardoso T, Ribeiro O, Aragão I, Costa-Pereira A, Sarmento A. Differences in microbiological profile between community-acquired, healthcare-associated and hospital-acquired infections. Acta Médica Portuguesa. 2013; 26:377-84. https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/208/3711doi:10.3892/br.2024.1805.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.