Impact of the COVID-19 pandemic on the incidence of multidrug-resistant bacterial infections in an acute care hospital in Brazil

Abstract

Background The impact of COVID-19 on healthcare- associated infections (HCAI) caused by multidrug-resistant (MDR) bacteria that contribute to higher mortality is a growing area of study Methods This retrospective observational study compares the incidence density (ID) of HCAI caused by MDR bacteria (CRE, CRAB, CRP, MRSA and VRE) pre-COVID (2017-2019) and during the COVID-19 pandemic (2020) in overall hospitalized patients and in intensive care (ICU) units. Results We identified 8,869 HCAI, of which 2,641 (29.7%) were caused by bacterial MDR, and 1,257 (14.1%) were from ICUs. The overall ID of MDR infections increased 23% ( p <0.005) during COVID-19. The overall per-pathogen analysis shows significant increases in infections by CRAB and MRSA (+108.1%, p&lt;0.005; +94.7%, p&lt;0.005, respectively), but not in CRE, CRP, or VRE. In the ICU, the overall ID of MDR infections decreased during COVID, but that decline was not significant (-6.5%, p =0.26). The ICU per-pathogen analysis of ID of infection showed significant increases in CRAB and MRSA (+42.0%, p=0.001; +46.2%, p=0.04), significant decreases in CRE and CRP (-26.4%, p =0.002; -44.2%, p =0.003, respectively) and no change in VRE. Conclusions The COVID-19 pandemic correlates to an increase in ID of CRAB and MRSA both in ICU and non-ICU setting, and a decrease in ID of CRE and CRP in the ICU setting. Infection control teams should be aware of possible outbreaks of CRAB and MRSA and promote rigorous adherence to infection control measures as practices change to accommodate changes in healthcare needs during and after the pandemic.

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“…But the prevalence of carbapenemresistant Klebsiella pneumoniae (CRKP) was not analysed in this study. 15 It was very interesting that in the ICUs of COVID-19 patients there was a lower prevalence of carbapenem-resistant Pseudomonas aeruginosa, MRSA, CREs (other than Klebsiella pneumoniae) and VRE. Reports from other cities in Brazil, for example São Paulo, showed an increase in VRE in some units.…”

“…Reports from other cities in Brazil, for example São Paulo, showed an increase in VRE in some units. 15 Another interesting aspect of the behavior of MDR bacteria during the SARS-Cov-2 pandemic was that, unlike what happened in the influenza A (H1N1) pandemic in 2009, where there was an increase in MRSA co-infections, 16,17 in the COVID-19 pandemic, there was an increase in the number of co-infections due to MDR Gram-negative bacteria and fungi. 18,19 Further studies are needed to understand whether it was the previous microbiological environment of the ICUs that amplified this dissemination of MDR bacteria or whether there are specific characteristics in the viral infections that predispose to colonization and infections by certain MDR bacterial groups.…”

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

“…Severe COVID-19 infection with respiratory failure requiring prolonged mechanical ventilation or use of extracorporeal membrane oxygenation is associated with an increased risk of secondary infections and emergence of MDR pathogens [ 101 •, 104 , 105 •]. Most studies addressing severely ill COVID-19 patients reported high rates of MDR pathogens [ 106 •, 107 ]. Furthermore, COVID-19 patient unit-level outbreaks due to MDR pathogens have been reported [ 108 – 110 ].…”

The Collateral Effects of COVID-19 Pandemic on the Status of Carbapenemase-Producing Pathogens

“…In one retrospective single-center, case-control study, authors from Spain reported that COVID-19 patients had increased risk of nosocomial infections with carbapenemase-producing Enterobacteriaceae , with infections being severe, appearing in critically-ill patients, and associated with a high mortality. The aforementioned infection was the cause of death in about two thirds of the studied patients ( Pintado et al., 2022 ). In Brazil, the COVID-19 pandemic was correlated to an increase in incidence of carbapenem-resistant A. baumannii both in ICU and non-ICU settings ( Polly et al., 2021 ).…”

“…The aforementioned infection was the cause of death in about two thirds of the studied patients ( Pintado et al., 2022 ). In Brazil, the COVID-19 pandemic was correlated to an increase in incidence of carbapenem-resistant A. baumannii both in ICU and non-ICU settings ( Polly et al., 2021 ). Likewise, the number of carbapenem-resistant Enterobacteriaceae isolated from COVID-19 patients in a Turkish hospital was higher than that isolated during an equal time period prior to the pandemic ( Karataş et al., 2021 ).…”