Abstract

Whether the risk of multidrug-resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is modified by the COVID-19 crisis is unknown. In this single center case control study, we measured the rate of MDRB acquisition in patients admitted in COVID-19 ICU and compared it with patients admitted in the same ICU for subarachnoid hemorrhage (controls) matched 1:1 on length of ICU stay and mechanical ventilation. All patients were systematically and repeatedly screened for MDRB carriage. We compared the rate of MDRB acquisition in COVID-19 patients and in control using a competing risk analysis. Of note, although we tried to match COVID-19 patients with septic shock patients, we were unable due to the longer stay of COVID-19 patients. Among 72 patients admitted to the COVID-19 ICUs, 33% acquired 31 MDRB during ICU stay. The incidence density of MDRB acquisition was 30/1000 patient days. Antimicrobial therapy and exposure time were associated with higher rate of MDRB acquisition. Among the 72 SAH patients, 21% acquired MDRB, with an incidence density was 18/1000 patient days. The septic patients had more comorbidities and a greater number of previous hospitalizations than the COVID-19 patients. The incidence density of MDRB acquisition was 30/1000 patient days. The association between COVID-19 and MDRB acquisition (compared to control) risk did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93–3.21)). Thus, we conclude that, despite strong physical isolation, acquisition rate of MDRB in ICU patients was at least similar during the COVID-19 first wave compared to previous period.

Highlights

  • The respiratory infection COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, being considered pandemic by the World Health Organization since 11 March 2020 [1].During this pandemic, health care systems worldwide became overloaded and experienced shortages of intensive care unit (ICU) beds [2] and protective personal equipment (PPE) [3]

  • The aim of this study is to describe the rate of multidrug-resistant bacteria (MDRB) acquisition in COVID-19 ICUs compared with the MDRB acquisition in the same department before the COVID-19 crisis

  • We identified 75 patients admitted to COVID-19 units during the studied period

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Summary

Introduction

The respiratory infection COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, being considered pandemic by the World Health Organization since 11 March 2020 [1].During this pandemic, health care systems worldwide became overloaded and experienced shortages of intensive care unit (ICU) beds [2] and protective personal equipment (PPE) [3]. In the most severely affected countries, ICUs were filled with only COVID-19 patients, and named “COVID-19 ICUs”; new ICUs and hospital beds had to be opened [4], health care professionals were reassigned and started working longer hours. These factors can contribute to a decreased adherence to infection prevention and control measures and, combined with a high antimicrobial selection pressure [5], may facilitate the emergence of antimicrobial resistance (AMR) [6]. The ICU is one of the hospital locations where patients have the highest risk of acquiring multidrug-resistant bacteria (MDRB) [11]

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