The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units.

Aleksa Despotovic,Ksenija Cucanic,Teodora Cucanic,Branko Milosevic,Goran Stevanovic,Andja Cirkovic,Ankica Vujovic

doi:10.3390/antibiotics10101146

Aleksa Despotovic, Ksenija Cucanic + Show 5 more

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https://doi.org/10.3390/antibiotics10101146

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Abstract

Hospital-acquired infections (HAIs) are a global public health concern. As the COVID-19 pandemic continues, its contribution to mortality and antimicrobial resistance (AMR) grows, particularly in intensive care units (ICUs). A two-year retrospective study from April 2019–April 2021 was conducted in an adult ICU at the Hospital for Infectious and Tropical Diseases, Belgrade, Serbia to assess causative agents of HAIs and AMR rates, with the COVID-19 pandemic ensuing halfway through the study. Resistance rates >80% were observed for the majority of tested antimicrobials. In COVID-19 patients, Acinetobacter spp. was the dominant cause of HAIs and more frequently isolated than in non-COVID-19 patients. (67 vs. 18, p = 0.001). Also, resistance was higher for imipenem (56.8% vs. 24.5%, p < 0.001), meropenem (61.1% vs. 24.3%, p < 0.001) and ciprofloxacin (59.5% vs. 36.9%, p = 0.04). AMR rates were aggregated with findings from our previous study to identify resistance trends and establish empiric treatment recommendations. The increased presence of Acinetobacter spp. and a positive trend in Klebsiella spp. resistance to fluoroquinolones (R2 = 0.980, p = 0.01) and carbapenems (R2 = 0.963, p = 0.02) could have contributed to alarming resistance rates across bloodstream infections (BSIs), pneumonia (PN), and urinary tract infections (UTIs). Exceptions were vancomycin (16.0%) and linezolid (2.6%) in BSIs; tigecycline (14.3%) and colistin (0%) in PNs; and colistin (12.0%) and linezolid (0%) in UTIs. COVID-19 has changed the landscape of HAIs in our ICUs. Approval of new drugs and rigorous surveillance is urgently needed.

Highlights

The burden of hospital-acquired infections (HAIs) on healthcare systems and patients is substantial and constantly growing
In our previous two-year study conducted before the pandemic [20], we identified risk factors for both acquisition and mortality in patients with HAIs in adult intensive care units (ICUs) and discovered high resistance rates to most tested antibiotics
A total of 114 patients suffered from at least one HAI, with their clinical and demographic characteristics shown in Table 1. 35.1% of patients were female, and the median length of stay (LOS) was 24 days (IQR 23)

Summary

Introduction

The burden of hospital-acquired infections (HAIs) on healthcare systems and patients is substantial and constantly growing. Recent surveys show that up to 4.5 million individuals suffer from at least one HAI in acute care hospitals across Europe every year [1,2,3]. Appropriate infection prevention and control has been challenging since the start of the COVID-19 pandemic, during which studies are showing an increase in HAI occurrence [4,5,6]. The sudden and enormous demands on healthcare systems has inevitably reduced the quality of infection control worldwide. The use of large amounts of antibiotics and immunosuppressive therapy in COVID-19 patients has only accentuated the problem of antimicrobial resistance (AMR) and the incidence of multidrug-resistant (MDR) organisms [8,9]

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