Healthcare-associated infections by multidrug-resistant bacteria in Andalusia, Spain, 2014 to 2021
Identificadores
URI: https://hdl.handle.net/10481/85554Metadata
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Fernández-Martínez, Nicolás Francisco; Rivera Izquierdo, Mario; Martínez Ruiz, Virginia Ana; Lardelli Claret, Pablo; Valero Ubierna, María del CarmenEditorial
European Centre for Disease Prevention and Control An agency of the European Union
Date
2023-09-28Referencia bibliográfica
Fernández-Martínez Nicolás Francisco, Rivera-Izquierdo Mario, Ortiz-González-Serna Rocío, Martínez-Ruiz Virginia, Lardelli-Claret Pablo, Aginagalde-Llorente Adrián Hugo, Valero-Ubierna María del Carmen, Vergara-Díaz María Auxiliadora, Lorusso Nicola. Healthcare-associated infections by multidrug-resistant bacteria in Andalusia, Spain, 2014 to 2021. Euro Surveill. 2023;28(39):pii=2200805. [https://doi.org/10.2807/1560-7917.ES.2023.28.39.2200805]
Abstract
Background: Multidrug-resistant (MDR) bacteria are
among chief causes of healthcare-associated infections
(HAIs). In Spain, studies addressing multidrug
resistance based on epidemiological surveillance
systems are lacking. Aim: In this observational study,
cases of HAIs by MDR bacteria notified to the epidemiological
surveillance system of Andalusia, Spain,
between 2014−2021, were investigated. Notified cases
and their spatiotemporal distribution were described,
with a focus on social determinants of health (SDoH).
Methods: New cases during the study period of
HAIs caused by extended-spectrum β-lactamase
(ESBL)-/carbapenemase-producing Enterobacterales,
MDR Acinectobacter baumannii, MDR Pseudomonas
aeruginosa or meticillin resistant Staphylococcus
aureus were considered. Among others, notification
variables included sex and age, while socio-economic
variables comprised several SDoH. Cases’ spatial
distribution across municipalities was assessed.
The smooth standardised incidence ratio (sSIR)
was obtained using a Bayesian spatial model.
Association between municipalities’ sSIR level and
SDoH was evaluated by bivariate analysis. Results:
In total, 6,389 cases with a median age of 68 years
were notified; 61.4% were men (n = 3,921). The
most frequent MDR bacteria were ESBL-producing
Enterobacterales (2,812/6,389; 44.0%); the main
agent was Klebsiella spp. (2,956/6,389; 46.3%).
Between 2014 and 2021 case numbers appeared to
increase. Overall, up to 15-fold differences in sSIR
between municipalities were observed. In bivariate
analysis, there appeared to be an association between
municipalities’ sSIR level and deprivation (p = 0.003).
Conclusion: This study indicates that social factors
should be considered when investigating HAIs by MDR
bacteria. The case incidence heterogeneity between
Andalusian municipalities might be explained by SDoH,
but also possibly by under-notification. Automatising
reporting may address the latter