Cent Eur J Public Health 2026, 34(2):105-110 | DOI: 10.21101/cejph.a8932

Pathogen occurrence and antimicrobial resistance in long-term care units before and after the COVID-19 pandemic: an analysis from a Polish district hospital (2017–2023)

Rafał Kuczma1, Szymon Barwiński1, Barbara Symula2, Katarzyna Jermakow3
1 Students' Scientific Association of Clinical Microbiology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
2 Laboratory of Microbiological Diagnostics, Healthcare Complex in Oława, Oława, Poland
3 Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland

Objectives: The study aimed to analyse trends in pathogen occurrence and antimicrobial resistance patterns in two long-term care (LTC) units operating within a Polish district hospital from 2017 to 2023, with a particular focus on changes across the COVID-19 pandemic.

Methods: A retrospective observational study was conducted using epidemiological and microbiological data from two LTC units (nursing home and inpatient hospice) in Poland. Isolation rates (per 1,000 patient-days) for ESKAPE pathogens and Clostridioides difficile were analysed. The pre-pandemic period (2017-2019) was compared with the pandemic/post-pandemic period (2020-2023) using rate ratios (RR). Trends in the proportion of resistant isolates among the dominant Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii) were evaluated based on phenotypic surveillance criteria.

Results: The inpatient hospice and nursing home exhibited different epidemiological profiles. In the hospice, ESKAPE pathogen isolation rates decreased significantly after 2020 (RR = 0.55, 95% CI: 0.37-0.81), whereas the detection rate of C. difficile quadrupled (RR = 4.39, 95% CI: 1.51-12.75). Isolation rates remained low and stable in the nursing home. Across both units, the proportion of antimicrobial-resistant isolates increased sharply during the pandemic period. Notably, in selected pandemic and post-pandemic years, all analysed E. coli and K. pneumoniae isolates exhibited the ESBL phenotype, while all analysed A. baumannii isolates were carbapenem-resistant.

Conclusions: The COVID-19 pandemic was associated with substantial changes in pathogen occurrence patterns in long-term care units and with increased antimicrobial resistance among key Gram-negative pathogens. The emergence of resistant phenotypes among clinically important Gram-negative pathogens, including ESBL-producing Enterobacterales and carbapenem-resistant A. baumannii isolates, poses a significant public health concern. These findings highlight the need for strengthened microbiological surveillance, antimicrobial stewardship, and infection prevention and control measures tailored to the specific care profiles of hospices and nursing homes.

Keywords: long-term care, antimicrobial resistance, pathogen surveillance, ESKAPE pathogens, Clostridioides difficile, COVID-19 pandemic

Received: January 27, 2026; Revised: May 24, 2026; Accepted: May 24, 2026; Published: June 30, 2026  Show citation

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Kuczma R, Barwiński S, Symula B, Jermakow K. Pathogen occurrence and antimicrobial resistance in long-term care units before and after the COVID-19 pandemic: an analysis from a Polish district hospital (2017–2023). Cent Eur J Public Health. 2026;34(2):105-110. doi: 10.21101/cejph.a8932.
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    References

    1. World Health Organization. Ageing and health [Internet]. Geneva: WHO; 2025 [cited 2025 Oct 29]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.
    2. OECD; European Union. Health at a glance: Europe 2024: state of health in the EU cycle. Paris: OECD Publishing; 2024.
    3. Theodorakis N, Feretzakis G, Hitas C, Kreouzi M, Kalantzi S, Spyridaki A, et al. Antibiotic resistance in the elderly: mechanisms, risk factors, and solutions. Microorganisms. 2024;12(10):1978. doi: 10.3390/microorganisms12101978. Go to original source... Go to PubMed...
    4. Haynes L. Aging of the immune system: research challenges to enhance the health span of older adults. Front Aging. 2020;1:602108. doi: 10.3389/fragi.2020.602108. Go to original source... Go to PubMed...
    5. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199-226. Go to original source... Go to PubMed...
    6. European Centre for Disease Prevention and Control. Antimicrobial resistance in the EU/EEA (EARS-Net): annual epidemiological report for 2023. Stockholm: ECDC; 2024.
    7. Ferraz MP. Antimicrobial resistance: the impact from and on society according to One Health approach. Societies. 2024;14(9):187. doi: 10.3390/soc14090187. Go to original source...
    8. European Commission. The 2018 ageing report: economic & budgetary projections for the 28 EU Member States (2016-2070). Luxembourg: Publications Office of the European Union; 2018.
    9. Grifoni C, Coppi M, Baccani I, Antonelli A, Bevilacqua L, Brambilla L, et al. Dealing with challenges posed by antimicrobial resistance in long-term acute-care rehabilitation facilities. Antibiotics (Basel). 2025;14(2):147. doi: 10.3390/antibiotics14020147. Go to original source... Go to PubMed...
    10. Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, et al. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020;25(22):2000956. doi: 10.2807/1560-7917.ES.2020.25.22.2000956. Go to original source...
    11. Malik SS, Mundra S. Increasing consumption of antibiotics during the COVID-19 pandemic: implications for patient health and emerging anti-microbial resistance. Antibiotics (Basel). 2022;12(1):45. doi: 10.3390/antibiotics12010045. Go to original source... Go to PubMed...
    12. Grant R, Benamouzig D, Catton H, Cheng VC, Dhingra N, Laxminarayan R, et al. COVID-19 pandemic: a catalyst for accelerating global action on patient safety. Lancet Infect Dis. 2023 Oct;23(10):1108-10. Go to original source... Go to PubMed...
    13. [Regulation of the Minister of Health of 23 December 2011 on the list of alert pathogens, registers of hospital infections and alert pathogens, and reports on the current epidemiological situation of the hospital]. Dziennik Ustaw. 2011 Dec 30;Pt 294:17195-205. Polish.
    14. Wojkowska-Mach J, Brudło M, Topolski M, Bochenek T, Jachowicz E, Siewierska M, et al. Antibiotic consumption in long-term care facilities in Poland and other European countries in 2017. Antimicrob Resist Infect Control. 2021;10(1):154. doi: 10.1186/s13756-021-01019-1. Go to original source... Go to PubMed...
    15. Voona S, Abdic H, Montgomery R, Clarkson A, Twitchell H, Hills T, et al. Impact of COVID-19 pandemic on prevalence of Clostridioides difficile infection in a UK tertiary centre. Anaerobe. 2022;73:102479. doi: 10.1016/j.anaerobe.2021.102479. Go to original source... Go to PubMed...
    16. Wright LM, Skinner AM, Cheknis A, McBurney C, Ge L, Pacheco SM, et al. Effect of the COVID-19 pandemic on rates and epidemiology of Clostridioides difficile infection in one VA hospital. Antibiotics (Basel). 2023;12(7):1159. doi: 10.3390/antibiotics12071159. Go to original source... Go to PubMed...
    17. Tossens B, Barthelme P, Briquet C, Belkhir L, Ngyuvula E, Soumillion K, et al. Impact of the COVID-19 pandemic on Clostridioides difficile infection in a tertiary healthcare institution in Belgium. Acta Clin Belg. 2023;78(6):459-66. Go to original source... Go to PubMed...
    18. Lewandowski K, Rosołowski M, Kaniewska M, Kucha P, Meler A, Wierzba W, et al. Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem? Pol Arch Intern Med. 2021;131(2):121-7. Go to original source... Go to PubMed...
    19. Slimings C, Riley TV. Antibiotics and healthcare facility-associated Clostridioides difficile infection: systematic review and meta-analysis 2020 update. J Antimicrob Chemother. 2021 Jun 18;76(7):1676-88. Go to original source...
    20. Deshwal PR, Fathima R, Aggarwal M, Reddy NS, Tiwari P. A systematic review and meta-analysis for risk factor profiles in patients with resistant Acinetobacter baumannii infection relative to control patients. Int J Risk Saf Med. 2023;34(4):337-55. Go to original source... Go to PubMed...
    21. Namikawa H, Imoto W, Yamada K, Tochino Y, Kaneko Y, Kakeya H, et al. Predictors for onset of extended-spectrum beta-lactamase-producing Escherichia coli-induced bacteraemia: a systematic review and meta-analysis. J Hosp Infect. 2023 Dec;142:88-95. Go to original source...
    22. Boton N, Larnard J. When should patients at the end of life get antimicrobials? AMA J Ethics. 2024;26(6):456-62. Go to original source... Go to PubMed...
    23. Eze N, Cecchini M, Cravo Oliveira Hashiguchi T. Antimicrobial resistance in long-term care facilities. OECD Health Working Papers No. 136. Paris: OECD Publishing; 2022.
    24. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities 2023-2024. Stockholm: ECDC; 2025.
    25. Mody L, Advani SD, Ashraf MS, Bartlett AH, Bradley SF, Burdsall DP, et al. Multisociety guidance for infection prevention and control in nursing homes. Infect Control Hosp Epidemiol. 2025;46(11):1069-96. Go to original source... Go to PubMed...

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