The prevalence of multidrug-resistant organisms in the burn units of three hospitals in the Free State and Northern Cape before, during and after the COVID-19 pandemic (1 March 2018–31 July 2024)

Abstract

INTRODUCTION Antimicrobial resistance (AMR) is a global health threat; it has no limits and knows no borders and can be found on every continent across the globe. The impact is evident with the sixfold increase of AMR that has been seen in the world since 2017. It has been estimated by researchers that by the year 2050 there will be 10 million deaths across the world because of untreatable strains, due to the misuse and overuse of antimicrobials that led to the extensive development of AMR. This study was done to determine the impact that the COVID-19 pandemic had on the further development of AMR by comparing the bacterial resistance pattern before, during and after the pandemic. METHODOLOGY This was a retrospective study, and retrospective data were used to conduct this research. The data that were requested were pre-pandemic (1 March 2018 until 30 February 2020), during the pandemic (1 March 2020 until 30 June 2022), and post-pandemic (1 July 2022 until 31 July 2024). The burn units of the public hospitals of the Free State and Northern Cape were chosen as the study site for the research. The hospitals in the Free State include Pelonomi, National, Universitas, Bongani Regional Hospital, Boitumelo and Mofumahadi Manapo Mopeli Hospital. The hospital of the Northern Cape is Robert Mangaliso Sobukwe. In this study we wanted to determine the resistance profile of the bacteria in the burn units and compare the resistance before, during and after the pandemic. RESULTS AND DISCUSSIONS This study compared the resistance in the burn units of the Northern Cape and Free State before, during and post-COVID-19. It was noted that in most cases, resistance increased during the pandemic, and it did not decrease to the levels it had been before the pandemic. A total of 1 606 samples were collected for this study, of which 1 549 were from the Free State and 57 from the Northern Cape. Due to the small sample size of the North Cape, the results largely reflect those of the Free State. In both provinces Pseudomonas aeruginosa and Staphylococcus aures were the most frequently isolated organisms. In both provinces Acinetobacter baumannii showed a concerning and persistently high resistance (above 80%). The overall resistance increased in the Free State during COVID-19 (35.01% to 38.64%) and increased further post-COVID-19 (39.59%). The resistance rose sharply during COVID-19 in the Northern Cape (28.77% to 52.78%), but the levels decreased again post-COVID-19 (21.05%). The decrease could be attributed to the small sample size for this timeframe. At the organism level, the resistance of Staphylococcus aureus decreased in the Free State from 32.19% pre-COVID-19 to 21.9% post-COVID-19, while the resistance increased drastically to 50% in the Northern Cape during COVID-19. The resistance of Pseudomonas aeruginosa was quite high. It spiked during COVID-19 in the Free State (37.39% to 57.49%) and then decreased slightly (49.49%). The resistance was 34.72% pre-COVID-19 in the Northern Cape with no further comparable data. The resistance of Klebsiella pneumoniae rose markedly during COVID-19 (36.65% to 53.33%) in the Free State and decreased slightly post-COVID-19 (45.03%). Streptococcus pyogenes, while Proteus mirabilis showed a slight decrease in resistance in the Free State over the three timeframes. Escherichia coli showed a sharp decrease in resistance during the pandemic in the Free State (21.5% to 3.92%), and this then increased slightly post-COVID-19 (9.62%). The patterns of increased in resistance post-COVID-19 levels confirm the need for the reinstatement of antimicrobial stewardship programmes in South Africa along with infection-prevention measures in the burn units in South Africa. CONCLUSION Overall, this study has shown that during COVID-19, the AMR increased in the burn units of the Northern Cape and the Free State. Post-pandemic it is shown that the resistance levels remained higher than the levels pre-pandemic. The organisms that are the most concerning was Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae due to the persistence in elevated resistance levels. The resistance patterns vary across the different timeframes for the different antimicrobial classes, with the most worrisome trends seen among the last-resort antimicrobials. However, a common trend is seen, and this is that the resistance levels did not go back to pre-COVID-19 levels. This highlights the urgency of the matter to firstly strengthen and then re-establish the antimicrobial stewardship programmes in South Africa, and then also to prioritize the infection prevention measure in the burn units. If there is no intervention, the resistant infections that are currently in these burn units will continue to threaten and cause further harm to these burn unit patients that are already vulnerable and further strain the South African healthcare systems.