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This is a Quantitative Study study.

October 27, 2025Open Access

Trends in Antimicrobial Resistance at a Greek Tertiary Hospital over a 7-Year Period, Including the COVID-19 Pandemic

Key Points

Overall antimicrobial resistance experienced a transient peak in 2021, indicating fluctuating trends influenced by the COVID-19 pandemic.
The study found significant increases in multidrug-resistant bacteria within the medical sector, highlighting the challenge posed by antimicrobial resistance.
Trend analysis employed Joinpoint regression to evaluate data obtained from patients over a seven-year span.
Findings underline the necessity for revisions in therapy guidelines and robust infection prevention strategies to improve patient outcomes.

Abstract

Background/Objectives: Antimicrobial resistance (AMR) remains a major global threat, with the COVID-19 pandemic influencing its dynamics, although its overall impact remains uncertain. This study analyzed seven-year AMR trends, including the pandemic period, in a tertiary care hospital in Greece that served as a COVID-19 referral center. Methods: Multiresistant bacteria isolated from all biological specimens of hospitalized patients between January 2018 and December 2024 were recorded and classified as multidrug- (MDR), extensively drug- (XDR), or pandrug-resistant (PDR). Overall AMR was defined as the sum of these categories. Annual incidences of overall AMR, its categories, and predominant Gram-negative (A. baumannii, K. pneumoniae, P. aeruginosa) and Gram-positive methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE) pathogens were analyzed for the entire hospital and by sector (medical, intensive care unit ICU, surgical). Bloodstream infection (BSI) AMR was also evaluated. Trend analysis was performed using Joinpoint regression. Results: Overall AMR exhibited a transient peak around 2021 across the hospital, except in the surgical sector. A significant rise in average annual percentage change (AAPC) occurred only in the medical sector (p < 0.001). PDR incidence increased hospital-wide (p < 0.001). K. pneumoniae, P. aeruginosa, MRSA, and VRE rose significantly in the medical sector, whereas ICU incidences remained largely stable despite the 2021 peak. A. baumannii showed no significant change. BSI-related AMR increased in the medical sector (p < 0.001) but not in the ICU (p = 0.2). Conclusions: Although overall AMR did not rise uniformly, PDR organisms increased hospital-wide. These findings support updating empiric therapy guidelines, reinforcing infection prevention measures, and translating surveillance data into targeted stewardship actions to enhance patient care.

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