ArticlePloS one2026
Changes in multidrug-resistant Enterobacteriaceae features among patients in the emergency room during the COVID-19 Omicron variant pandemic.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The purpose of this study was to investigate stage-specific changes in risk factors and resistance patterns for multidrug-resistant Enterobacteriaceae (MDRE) bloodstream infections in emergency department (ED) patients during the COVID-19 Omicron wave. This retrospective cohort study focused on the ED of a tertiary care medical center in Taiwan from January 2022 to January 2023. Participants were adult ED patients (≥20 years) with positive blood cultures for Enterobacteriaceae and complete antimicrobial susceptibility testing (AST) data. Pandemic phases were defined using national surveillance data: Stage I (pre-peak), Stage II (epidemic peak), Stage III (post-peak). An exposome-wide association study identified stage-specific clinical and laboratory variables associated with MDRE infection. Resistance trends for key bacteria-antibiotic pairs were analyzed across stages. Of 1,269 screened ED patients, 816 met inclusion criteria; 287 (35.2%) had MDRE. In Stage I, age 75-85 years (OR 2.48, 95% CI 1.16-5.43) and ≥85 years (OR 2.29, 95% CI 1.07-5.00), along with RBC, Hb, and Hct, were associated with MDRE. In Stage II, platelet count (OR 1.00, 95% CI 1.00-1.01) and ALT (OR 1.00, 95% CI 0.99-1.00) were associated. In Stage III, WBC (OR 1.04, 95% CI 1.00-1.08), segmented neutrophils (OR 1.03, 95% CI 1.00-1.05), Hb, and Hct were associated. Klebsiella pneumoniae maintained 100% ampicillin resistance with rising ciprofloxacin resistance, while Escherichia coli showed declining resistance to multiple agents. In conclusion, MDRE-associated variables and resistance patterns varied across pandemic stages, supporting the need for dynamic, stage-adapted risk assessment and antimicrobial stewardship strategies in acute care settings.
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