Impact of Antibiotic Consumption on the Acquisition of Extended-Spectrum β-Lactamase Producing Enterobacterales Carriage during the COVID-19 Crisis in French Guiana

Abstract

(1) Background: During the COVID-19 outbreak, several studies showed an increased prevalence of extended-spectrum β-lactamase producing Enterobacterales (ESBL-PE) carriage in intensive care units (ICUs). Our objective was to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 crisis. (2) Methods: We conducted an observational study between 1 April 2020, and 31 December 2021, in the medical-surgical ICU of the Cayenne General Hospital. We defined two periods: Period 1 with routine, empirical antibiotic use, and Period 2 with no systematic empiric antibiotic prescription. (3) Results: ICU-acquired ESBL-PE carriage was 22.8% during Period 1 and 9.4% during Period 2 (p = 0.005). The main isolated ESBL-PE was Klebsiella pneumoniae (84.6% in Period 1 and 58.3% in Period 2). When using a generalized linear model with a Poisson family, exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition in ICU (p = 0.002, IRR 2.59 (95% IC 1.42–4.75)). The propensity scores matching estimated the increased risk for cefotaxime use to acquire ESBL-PE carriage at 0.096 (95% CI = 0.02–0.17), p = 0.01. (4) Conclusions: Exposure to cefotaxime in patients with severe COVID-19 is strongly associated with the emergence of ESBL-PE in the context of maximal infection control measures.

The Impact of COVID-19 Pandemic on ESBL-Producing Enterobacterales Infections: A Scoping Review

“…An observational study conducted between April 2020 and December 2021 in a hospital in French Guiana to assess the impact of antibiotic prescriptions on the acquisition of ESBL-PE in ICUs during the COVID-19 pandemic reported that ESBL-PE carriage ranged from 10% to 22% among ICU patients hospitalized during that period, and K. pneumoniae (58.3% to 84.6%) was the ESBL-PE most frequently isolated. Surprisingly, the investigators observed that exposure to cefotaxime was the only factor independently associated with ESBL-PE acquisition among ICU patients with severe COVID-19 [ 39 ].…”

“…All eight studies published so far were retrospective studies. Three studies (1829 patients), in addition to the frequency of ESBL-PE, also provided clinical and epidemiological aspects of the studied patients [ 39 , 41 , 44 ], while the remaining five studies were solely focused on the presence or lack of ESBL-PE in patient-derived specimens (mainly urine samples) and provided no clinical data from the affected patients [ 40 , 42 , 43 , 45 , 48 ]. The largest study that involved patients was conducted in Italy (1617 patients) and reported a higher incidence of ESBL-PE among patients hospitalized for severe COVID-19 (mainly caused by Kp-ESBL) compared with those admitted for other conditions, suggesting that COVID-19 may predispose patients to colonization and thereby infection with ESBL-PE, likely due to the higher frequency of these patients undergoing invasive procedures, such as invasive ventilation and long-term exposure to catheters [ 41 ].…”