'Double Trouble' -Antimicrobial resistance and COVID-19 A study on health care associated infections and multidrug resistant organisms in critical care units during the global pandemic

Abstract

INTRODUCTION: Healthcare-associated infections (HAIs) contribute to mortality and morbidity in critical care units. The influence of the ongoing coronavirus disease (COVID-19) pandemic on the already existing silent pandemic of antimicrobial resistance, especially in a critical care setting in our experience, is discussed here in this perspective.MATERIALS AND METHODS: In our prospective single-centred study over three months (July to September 2020), 123 COVID-19-positive patients admitted in the medical and surgical intensive care units (ICUs) were enrolled after institutional ethical clearance and informed consent. Patient characteristics and risk factors for HAIs were studied using univariate analysis. Antimicrobial usage was monitored based on high-end antibiotic usage monitoring policy.RESULTS: Of 123 COVID-19 patients, 98 were mechanically ventilated and 47% (46/98) developed ventilator-associated pneumonia (VAP) with predominant strain of multidrug-resistant (MDR) Klebsiella pneumoniae. In patients with central line, 26% (10/38) developed central line-associated bloodstream infection (CLABSI) with coagulase-negative Staphylococcus. In catheterised patients, 51% (23/45) developed catheter-associated urinary tract infection (CAUTI) with predominant MDR K. pneumoniae and Acinetobacter baumannii complex. The significant risk factors for VAP were acute respiratory distress syndrome (ARDS), acute kidney injury, duration of mechanical ventilation, steroid therapy and longer ICU length of stay. Patients with CAUTI had diabetes and chronic kidney disease, were on steroids and had a longer ICU stay. Patients with CLABSI had more ARDS, had diabetes, were mechanically ventilated longer and had longer ICU stay. A 57%–84% increase in consumption of antibiotics was seen in our set-up with Azithromycin, Colistin, Meropenem and newer β-lactam/β-lactamase inhibitor combinations like Ceftazidime/Avibactam.CONCLUSION: HAIs in a critical setting with patients admitted with COVID-19 need special focus in terms of prevention and control. In our study, we highlight the incidence of VAP and a need to monitor these key quality indicators including antimicrobial prescription practices.