During the first 3 years of the pandemic, at least 255 healthcare workers (HCWs) around the world were attacked, 18 were killed, 147 were injured, and 86 facilities were damaged, finds a report published last week in Health Security.

Led by researchers in the Netherlands, the study extracted data on global COVID-related attacks against HCWs from the Safeguarding Health in Conflict Coalition database from January 2020 to January 2023. The team included incidents related to COVID-19 public health measures or interference with COVID-19 care, including attacks related to conflict.

"During the COVID-19 pandemic, violence targeting healthcare reportedly increased," the researchers wrote. "Attacks against healthcare can severely hamper the public health response during a pandemic."

Likely an undercount

During the study period, 255 COVID-19-related attacks on HCWs were reported, with 18 killed and 147 injured, in addition to damage to 86 facilities. Attacks were most common at the beginning of the pandemic and primarily consisted of "stigma-related" attacks on HCWs. 

The findings of this study emphasize the importance of public education campaigns, improved coordination between healthcare organizations and law enforcement, and the possible need to bolster the security of medical facilities and health workers.

Incidents in 2021 included those against vaccination campaigns and conflict-related attacks that interfered with COVID-19 care. Such incidents were reported in heterogeneous contexts throughout the pandemic.

"Due to underreporting, the data presented are a minimum estimate of the actual magnitude of violence," the study authors wrote. "The findings of this study emphasize the importance of public education campaigns, improved coordination between healthcare organizations and law enforcement, and the possible need to bolster the security of medical facilities and health workers."

An analysis of veterinary data from Germany found that about 12% of Escherichia coli isolates from the country's dogs and cats are resistant to third-generation cephalosporins, researchers reported yesterday in PLOS One.

In the study, a team led by researchers from Germany's Institute of Veterinary Epidemiology and Biostatistics analyzed antimicrobial susceptibility test results obtained from 3,491 veterinary practices in Germany (33% of all practices nationwide) from 2019 through 2021 through GERM-Vet, Germany's monitoring system for resistant pathogenic bacteria in animals. Out of 175,171 samples, they evaluated 25,491 E coli strains for resistance to several antibiotic classes, focusing on cefovecin, the only third-generation cephalosporin approved for veterinary use. 

Third-generation cephalosporin-resistant E coli is considered a significant health threat in both people and animals, and the study authors note that cefovecin resistance can be reasonably compared to resistance to other third-generation cephalosporins. Third-generation cephalosporin-resistant E coli in companion animals is a particular concern because of the potential for transmission to owners.

"Due to the close contact between pet animals and their owners, information on resistance-carrying pathogens in companion animals is crucial for human health as well," the study authors wrote. "Knowledge about the occurrence and distribution are needed to gain further understanding and contribute to the One Health aspect of AMR [antimicrobial resistance]."

Data highlight need for integrated AMR surveillance

The proportion of E coli isolates that were resistant to cefovecin was 11.6%, with a similar proportion found in dogs (11.6%) and cats (11.7%). But there was notable local variation, with some regions showing resistance proportions around 15%. In addition, cefovecin-resistant E coli showed higher resistance levels to other antibiotics, specifically 30% for trimethoprim-sulfamethoxazole, 28% for chloramphenicol, 18% for enrofloxacin, and 14% for gentamicin.

The authors acknowledge that more research is needed to determine how often third-generation cephalosporin-resistant E coli is exchanged between pets and their owners, but they say the findings demonstrate the importance of integrated AMR surveillance.

"Accurate knowledge of antibiotic resistance in animal pathogens is crucial for the optimal use of antibiotics and benefits human and animal health," they concluded.

Data collected from hospitals in South Africa's third most populous province highlight the patients who are bearing the burden of rising rates of carbapenem-resistant Enterobacterales (CRE) in the country, researchers reported yesterday in PLOS One.

Using routine clinical and laboratory datasets, researchers from Stellenbosch University analyzed all CRE episodes (including clinical episodes and carriage) at hospitals in Western Cape province from 2016 through 2020. With CRE becoming an increasing problem at hospitals across the country but little local data on it, they wanted to describe the epidemiology of CRE carriage and infection, examine patient demographics and resistance phenotypes, and identify factors associated with mortality.

A total of 2,242 CRE episodes (70.5% clinical episodes and 29.5% carriage) were identified over the study period. Among the 2,281 CRE isolates identified, the most common species were Klebsiella spp (72.1%), Enterobacter cloacae (15.1%), and Escherichia coli (5.5%). Affected patients were mostly male (52%) and had a median age of 31 years. Most CRE episodes occurred in hospitalized patients (93%) and were recorded in central hospitals (70%).

The proportions of CRE isolates that were non-susceptible to imipenem and meropenem were 77.6% and 74.6%, respectively, and resistance to other beta-lactam antibiotics exceeded 98%. 

Factors associated with death

Among the 2,109 CRE episodes with available outcome data, 20.4% of patients died; crude in-hospital mortality rates were significantly higher for CRE clinical episodes (26.9%) than for CRE carriage episodes (6.4%). 

Factors that showed a statistically significant association with in-hospital mortality were female sex (adjusted odds ratio [aOR], 1.40; 95% confidence interval [CI], 1.09 to 1.56)], adult patients (aOR, 1.76; 95% CI, 1.20 to 2.57), CRE isolation from a sterile specimen (aOR, 0.41; 95% CI, 0.32 to 0.53), and more than 3 days between hospital admission and specimen collection (aOR, 1.56; 95% CI, 1.11 to 2.18).

"It is important to identify these factors to improve patient outcomes, to guide treatment strategies, enhance infection prevention and control (IPC) measures and to address the broader public health and economic implications of CRE infections," the study authors wrote. "This ultimately impacts the greater fight against [antimicrobial resistance] and the improvement of health care."