Global Distribution Patterns of Carbapenemase-Encoding Bacteria in a New Light: Clues on a Role for Ethnicity

Abstract

Antibiotic resistance represents a major global concern. The rapid spread of opportunistically pathogenic carbapenemase-encoding bacteria (CEB) requires clinicians, researchers, and policy-makers to swiftly find solutions to reduce transmission rates and the associated health burden. Epidemiological data is key to planning control measures. Our study aims to contribute by providing an analysis of 397 unique CEB isolates detected in a tertiary hospital in Germany. We propose new findings on demographic variables to support preventive sanitary precautions in routine clinical practice. Data on detected CEB was combined with patient’s demographic and clinical information for each isolate. Multiple regression techniques were applied to estimate the predictive quality of observed differences. Our findings confirm the role of age and gender in CEB colonization patterns and indicate a role for ethnicity and domicile. Also, carbapenemase-encoding A. baumannii was most frequently introduced to the hospital, while the risk of colonization with VIM-encoding P. aeruginosa rose with the length of hospital stay. P. aeruginosa remains an important complication of prolonged hospital stays. The strong link to hospital-wastewater may have implications for hospital-built environments. A. baumannii can be efficiently controlled from spreading at hospital admission. OXA-encoding CEB being harder to detect in routine screening, targeted preventive measures, such as culture media selective for carbapenem-resistant bacteria, would be opportune for patients from selected regions. The CEB differences linked to ethnicity found in our study may further be supporting the tailoring of diagnostic approaches, as well as health policies upon confirmation by other studies and a better understanding of their global distribution.

Global Threat of Carbapenem-Resistant Gram-Negative Bacteria

“…An outbreak of XDR- P. aeruginosa infections was reported in a tertiary care pediatric hospital in Italy between 2011 and 2012 ( Ciofi Degli Atti et al., 2014 ). The risk of colonization with CP- P. aeruginosa isolates harboring bla VIM was also reported to apparently increase with the length of hospital stay (especially > 30-day durations) ( Neidhöfer et al., 2021 ).…”

“…A study conducted at a German hospital by Neidhöfer et al. observed that the bla OXA-23 -encoding A. baumannii complex was more frequently introduced into the hospital by patients residing in the Arabian Peninsula than those of German ethnicity, raising the concern of ethnic factors affecting the infection due to CP- A. baumannii ( Neidhöfer et al., 2021 ). Furthermore, nosocomial infections due to MDR- A. baumannii complex in pediatrics hospitalized at ICU were reported in Turkey ( Ozdemir et al., 2011 ).…”

Examining Different Analysis Protocols Targeting Hospital Sanitary Facility Microbiomes

“…However, it is also possible that the lack of a rich, diverse microbiome may negatively impact patient outcomes. Without a diverse microbial community, pathogens that would otherwise be displaced could thrive [ 9 , 12 , 13 , 14 , 15 , 16 , 17 , 32 , 33 ].…”

An 18-Year Dataset on the Clinical Incidence and MICs to Antibiotics of Achromobacter spp. (Labeled Biochemically or by MAL-DI-TOF MS as A. xylosoxidans), Largely in Patient Groups Other than Those with CF

“…Because these patients are more vulnerable to opportunistic infections, they receive antibiotic courses more frequently than other patient groups. These eradicate most potential opportunistic pathogens but also damage the host's beneficial and protective microflora, and can ultimately lead to environmental bacteria with intrinsic resistance mechanisms, such as A. xylosoxidans to be capable of settling down in the gastrointestinal tract [53][54][55][56][57][58]. These patient groups will therefore benefit from further studies on the hospital microenvironment in order to identify and seal potential sources of infection, and from studies on how protective microbiome factors can be maintained despite antibiotic therapies.…”