Distinct Epidemiology and Temporal Trends of Multidrug-Resistant Organisms in a Newly Established Hospital: A Five-Year Surveillance Study

Vollständiger Abstract

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Background: Antimicrobial resistance is a major global health challenge, with multidrug-resistant organisms (MDROs) emerging faster than new antimicrobial agents are being developed. The epidemiology of MDROs varies substantially across healthcare settings; however, newly established hospitals remain understudied. This study aimed to characterise the epidemiology and temporal trends of MDROs in a newly established tertiary hospital. Methods: A five-year retrospective longitudinal surveillance study was conducted from 2019 to 2023 in a newly established tertiary hospital in Southern China. Clinical isolates were collected from intensive care unit (ICU) and non-ICU wards. Nine major MDROs were investigated, including extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) and Escherichia coli (ESBL-ECO); carbapenem-resistant Klebsiella pneumoniae (CRKP), Escherichia coli (CRECO), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA); methicillin-resistant Staphylococcus aureus (MRSA); and vancomycin-resistant Enterococcus faecium (VREfm) and Enterococcus faecalis (VREfa). Results: A total of 1533 MDRO isolates were identified during the study period. The predominant pathogens were ESBL-ECO (48.1%), ESBL-KP (16.4%), MRSA (11.4%), and CRPA (11.1%). Most isolates were recovered from non-ICU wards (85.4%), and more than half (51.5%) were community-onset. Isolation rates of ESBL-ECO, CRECO, CRAB, and CRPA were significantly higher in the ICU than in non-ICU wards (all p < 0.05). The incidence density rate of hospital-acquired infections caused by ESBL-KP, CRAB, and CRPA was also significantly higher in the ICU (all p < 0.05). Longitudinal analysis revealed divergent trends among MDROs. While most MDRO isolation rates remained below provincial and national benchmark levels, CRKP and CRAB showed significant increasing trends. CRPA exhibited a distinct pattern, increasing rapidly during the early years after hospital opening, exceeding both provincial and national benchmarks by the second year and remaining elevated thereafter. Conclusions: MDRO epidemiology during the first five complete calendar years after hospital opening was characterised by a predominance of ESBL-ECO, ESBL-KP, MRSA, and CRPA, together with substantial non-ICU and community-onset burdens and heterogeneous temporal patterns across organisms. CRPA increased rapidly and remained above the available external benchmark thereafter. These findings highlight the need for hospital-wide, organism-specific MDRO surveillance, while maintaining intensified infection prevention and control in ICUs and continued vigilance for carbapenem-resistant pathogens, particularly CRPA.