No increase of device associated infections in German intensive care units during the start of the COVID-19 pandemic in 2020

Abstract

Background The COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019. Methods We utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019–2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days; device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models. Results The number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed. Conclusions The lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.

The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review

“… 15 , 16 Germany, where only 5% of the country was infected with COVID-19 in early 2020, did not see an increase in HAIs during the first months of the pandemic. 24 In contrast, countries such as the USA, where an estimated 13% of the population had COVID-19 in early 2020, noted a concurrent rise in HAIs. 24 Similarly, a retrospective study of CLABSIs in the USA found that in hospitals where >10% of admitted patients had COVID-19 there were significantly higher rates of CLABSIs compared with hospitals where COVID-19 accounted for <5% of admissions.…”

“… 24 In contrast, countries such as the USA, where an estimated 13% of the population had COVID-19 in early 2020, noted a concurrent rise in HAIs. 24 Similarly, a retrospective study of CLABSIs in the USA found that in hospitals where >10% of admitted patients had COVID-19 there were significantly higher rates of CLABSIs compared with hospitals where COVID-19 accounted for <5% of admissions. 25 VAPs increased across Europe 26–28 and North 8 , 9 , 17 and Latin America.…”

Healthcare-associated infections in Dutch hospitals during the COVID-19 pandemic

“…This is also reflected by the high antibiotic use observed in these patients, which will increase risk of antibiotic resistance. In Germany, there was no ICU overcrowding due to COVID-19 patients because of their high ICU bed capacity as compared with the Netherlands, and no increase in device-associated infections was observed in this country [ 33 ]. In addition, COVID-19 patients in general are more exposed to known risk factors for HAIs such as longer durations of mechanical ventilation, higher number of CVCs inserted, corticosteroid treatment, prone positioning, and longer lengths of stay [ 24 ].…”

Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)

“…In previous reports, COVID-19 was reported to be associated with increased rates of healthcare-associated infections (HAIs). [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] These results could be attributed to the neglect of conventional infection control practices, such as monitoring of handwashing activities and contact precautions for multidrug-resistant organisms. On the other hand, the COVID-19 pandemic has led to the strengthening of personal protective equipment usage in healthcare facilities.…”