Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit

Claudia Isonne,Paolo Villari,Francesco Alessandri,Maria De Giusti,Corrado De Vito,Giancarlo Ceccarelli,Mattia Marte,Carolina Marzuillo,Francesco Pugliese,Leonardo Maria Siena,Guglielmo Tellan,Stefano Zanni,Shadi Orlandi,Arianna Bellini,Giuseppe Migliara,Valentina Baccolini,Alessandro Territo,Daniela Marotta,Mariateresa Ceparano,Eleonora Ricci,Elisa Mazzeo,Matteo Piattoli,Marta Castellani,Ludovica D’Agostino,Elena Mazzalai,Irma Germani,Andrea Bongiovanni,Dara Giannini,Andrea Giorgi ,Chiara Marchi ,Lavinia Barone

doi:10.3390/jcm11051446

Abstract

The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

Highlights

The coronavirus disease 2019 (COVID-19) pandemic has imposed many challenges on healthcare systems worldwide [1]
The cumulative observation time from intensive care unit (ICU) admission to the end of follow-up was longer in the COVID-19 cohort in all but period II
Evidence from the literature suggests that COVID-19 patients have an increased risk of healthcare-associated infection (HAI) for a number of reasons, including their clinical condition, which often requires the use of invasive devices; a long ICU stay; and high rates of antibiotic administration, and because of difficulties in their management as a result of the reorganization of healthcare facilities [9,11,22,34]

Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has imposed many challenges on healthcare systems worldwide [1]. Healthcare activities were rapidly reorganized, and some wards, especially intensive care units (ICUs), had to increase their capacity [6,7]. Within this context, the application of appropriate measures to prevent and control healthcareassociated infections (HAIs) has been critical, with both surveillance efforts and containment strategies sometimes failing [8,9]. Recent evidence shows that patients hospitalized in ICUs during the pandemic have been at increased risk of HAIs [10,11]. The rationalization of ICU beds because of the pandemic may have determined a change in the pattern of patient admission, limiting it to extremely critical patients who could not be managed in other wards [19–21]

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