Profile of bacterial resistance in emergency wards, non-intensive care unit areas, and intensive care units in Mexican hospitals with the antimicrobial stewardship program

Objectives: Bacterial infections are important causes of death. Some reports have shown that the COVID-19 pandemic may have had an impact on drug resistance. The objective of this work was to compare the resistance profiles between 2019 and 2020 in the emergency department, non-intensive care units (ICU), and ICU areas in Mexican hospitals.

Methods: Databases from 15 hospitals from eight states in Mexico including susceptibility results for Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa collected from blood, urine, respiratory, and intra-abdominal secretions were analyzed. Different hospital areas were included: emergency department, non-ICU wards, and ICU. The databases were converted using the BacLink2 tool and analyzed using the WHONET 2022 platform. The percentage of antibiotic resistance was compared for each species and clinical specimen between years (2019 vs 2020) by a chi-square test using the criterion of P <0.05 for statistical significance.

Results: A statistically significant decrease in resistance to imipenem was observed for P. aeruginosa recovered from respiratory specimens in the ICU (55.6% vs 39.3%) and from urine samples from non-ICU areas (52.9% vs 37.3%). Also, an increase in resistance was detected in blood isolates from non-ICU areas for carbapenems in P. aeruginosa imipenem (23.3% vs 54.5%) and meropenem (27.4% vs 49%) and in E. coli, ertapenem (2.4% vs 10.1%), imipenem (1.9% vs 13.2%), and meropenem (1.6% vs 6.8%). Furthermore, an increase in resistance forimipenem (20.0% vs 57.5%) and meropenem (17.6% vs 48.7%) was detected in the emergency department for P. aeruginosa in respiratory isolates.

Conclusions: A decrease in carbapenem resistance for P. aeruginosa recovered from respiratory specimens in the ICU and from urine samples from non-ICU areas was detected. In contrast, an increase in carbapenem resistance was detected for P. aeruginosa in blood isolates from non-ICU areas and respiratory isolates from the emergency department. Regarding respiratory samples, a higher resistance for meropenem was detected in 2020 than in 2019 for K. pneumoniae (2.6 vs 10.6%, P = 0.05). These results underline the analysis of antimicrobial resistance in different hospital wards to focus efforts on antimicrobial resistance reduction.