The impact of the COVID pandemic on the frequency of clinical isolates of Acinetobacter baumannii at the University Hospital of Split

Cilj istraživanja: Odrediti učestalost kliničkih izolata Acinetobacter baumannii u tromjesečnom razdoblju praćenja prije i tijekom COVID-19 pandemije u Republici Hrvatskoj te usporediti broj i osjetljivost kliničkih izolata A. baumannii u KBC Split. Materijali i metode: U retrospektivnom, presječnom istraživanju pregledana je dostupna klinička literatura, a podaci koji se odnose na razdoblje 2017.-2021. godine prikupljeni su iz službenih publikacija Odbora za praćenje rezistencije bakterija na antibiotike u Republici Hrvatskoj te iz arhive Kliničkog zavoda za mikrobiologiju i parazitologiju KBC-a Split. Podaci su obrađeni korištenjem programskoga paketa Microsoft Office 365. Rezultati: U razdoblju od 2017. do 2021. godine, u Republici Hrvatskoj uočen je porast uzoraka A. baumannii, s najvećim brojem kliničkih izolata u 2020. (N=2060) i 2021. godini (N=2620), dok je najmanji broj uzoraka prikupljen 2017. godine (N=1563). U skladu s tim, u KBC-u Split zabilježen je značajan porast broja dobivenih uzoraka, s maksimalnim rezultatom u 2020. godini (N=295), dok se potom 2021. godine prati pad broja izolata sa zabilježenom minimalnom vrijednošću (N=133). Kad je riječ o osjetljivosti na antibiotike, najveća rezistencija A. baumannii u KBC Split zabilježena je na imipenem, meropenem i ciprofloksacin, nakon čega slijede i gentamicin te amikacin, dok je najveći broj kliničkih izolata pokazao osjetljivost na kolistin (oko 99%) te na fiksnu kombinaciju ampicilina i sulbaktama. Zbog povećane rezistencije na antibiotike, novi se sojevi A. baumannii karakteriziraju kao MDR. Zaključak: Rezultati ovog istraživanja pokazuju povećanje broja kliničkih izolata A. baumannii za vrijeme COVID pandemije, što je u skladu s hipotezom diplomskog rada. Smanjenjem broja oboljelih smanjuje se rizik potrebe za hospitalizacijom, poglavito najtežih bolesnika u Jedinice intenzivnog liječenja, te se usporedno smanjuje i broj infekcija uzrokovanih MDR A. baumannii. Buduća bi istraživanja trebala utvrditi rizik od smrtnog ishoda u slučaju dvostruke infekcije, odnosno bakterijske koinfekcije u COVID-19 pacijenata, te se svim bolesnicima, osobito starijima i s komorbiditetima, preporučuje cijepljenje kako bi se osigurala prikladna imunološka zaštita.Objective: To determine the frequency of clinical isolates of Acinetobacter baumannii in the three-month monitoring period before and during the COVID-19 pandemic in the Republic of Croatia, and to compare the number and sensitivity of clinical isolates of A. baumannii at the University Hospital of Split. Materials and methods: In a retrospective, cross-sectional study, available clinical literature was reviewed, and data related to the period 2017-2021 were collected from the official publications of the Committee for Monitoring Bacterial Resistance to Antibiotics in the Republic of Croatia and from the archives of the Clinical Institute for Microbiology and Parasitology of the University Hospital of Split. The data was processed using the Microsoft Office 365 software package. Results: In the period from 2017 to 2021, an increase in A. baumannii samples was observed in the Republic of Croatia, with the highest number of clinical isolates in 2020 (N=2060) and 2021 (N=2620), while the lowest number of samples was collected in 2017 (N=1563). Accordingly, a significant increase in the number of samples obtained was recorded at the University Hospital of Split, with the maximum result in 2020 (N=295), while a decrease in the number of isolates with a recorded minimum value (N=133) was observed in 2021. . When it comes to sensitivity to antibiotics, the highest resistance of A. baumannii at the University Hospital of Split was recorded to imipenem, meropenem and ciprofloxacin, followed by gentamicin and amikacin, while the largest number of clinical isolates showed sensitivity to colistin (around 99%) and to a fixed combination of ampicillin and sulbactam. Due to increased resistance to antibiotics, new strains of A. baumannii are characterized as MDR. Conclusion: The results of this research show an increase in the number of clinical isolates of A. baumannii during the COVID pandemic, which is in line with the thesis hypothesis. By reducing the number of patients, the risk of the need for hospitalization is reduced, especially for the most serious patients in Intensive Care Units, and the number of infections caused by MDR A. baumannii is also reduced. Future research should determine the risk of death in case of double infection, i.e. bacterial co-infection in COVID-19 patients, and vaccination is recommended for all patients, especially the elderly and those with comorbidities, in order to ensure adequate immune protection