Surveillance of bacterial antibiotic resistance in outpatient care and nursing homes. Mission Primo: 2022 Results
Introduction: The Primo initiative aims to monitor and prevent antibiotic resistance and healthcare-associated infections in community healthcare settings and the medical-social sector. The 2022 national data on antibiotic resistance in community settings and nursing homes focus on three bacterial species of interest (Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus). Method: From January 1 to December 31, 2022, susceptibility test results for E. coli, K. pneumoniae, and S. aureus isolated from diagnostic specimens were collected from a network of 1,773 clinical laboratories (LBM) spread across the 13 regions of mainland France, Réunion, and French Guiana. The Spares initiative collected susceptibility testing data from nursing homes and healthcare facilities. Susceptibility testing data for strains isolated from patients living at home or nursing home residents were included in the analysis. Screening samples and samples from healthcare facilities were excluded. Antibiotic resistance was compared between C3G-susceptible and C3G-resistant strains. The proportions of pan-susceptible strains and strains resistant to one or more antibiotics (multidrug-resistant bacteria) were calculated. Statistical analyses were performed using Student’s t-test or analysis of variance. Results: In 2022, 791,185 antibiotic susceptibility test results for Enterobacteriaceae strains isolated from urine samples were collected by the Primo and Spares initiatives (of which 85.0% were E. coli and 9.9% were K. pneumoniae). Among patients living at home, 3.3% of isolated E. coli strains were resistant to third-generation cephalosporins (C3G) and 3.0% produced extended-spectrum beta-lactamases (ESBLs). Among nursing home residents, resistance to 3G was observed in 8.5% of E. coli strains, and 7.7% were ESBL-producing. Fluoroquinolone (FQ) resistance in E. coli was 12.6% for strains isolated from community-dwelling patients and 18.7% for those isolated from nursing home residents. In K. pneumoniae, ESBL production was observed in 7.7% of strains isolated from home-dwelling patients and 19.0% of those isolated from nursing home residents, while 12.4% of strains were resistant to FQs among home-dwelling patients and 24.2% among nursing home residents. One hundred twelve strains of E. coli and 84 strains of K. pneumoniae produced a carbapenemase in home-dwelling patients, and 16 strains in nursing home residents for both species. For S. aureus, 6.9% of strains isolated from patients living at home (excluding urine samples) were methicillin-resistant, and 35.2% in nursing homes. Conclusion: Since 2017, the percentage of urinary E. coli strains producing ESBL has stabilized in outpatient care and decreased in nursing homes, while resistance to fluoroquinolones has increased in outpatient care and decreased in nursing homes. A small number of carbapenemase-producing Enterobacteriaceae were isolated from diagnostic specimens in community care and nursing homes in 2022; however, their increase warrants monitoring. Both fosfomycin and nitrofurantoin maintained good efficacy against E. coli strains in both settings.
Author(s): Lemenand Olivier, Thibaut-Jovelin Sonia, Coeffic Thomas, Caillon Jocelyne
Publishing year: 2024
Pages: 102 p.
Collection: Monitoring data
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