Unexpected benefit of COVID-19 hospital restrictions: Reduction in patients isolating with multidrug resistant organisms after restrictions were lifted

Abstract

Background During the COVID-19 pandemic, measures to prevent microorganism transmission were implemented across hospitals, including wearing compulsory surgical masks, minimising non-urgent procedures and restricting visitors. Previously, concerns have been raised that MRO-associated deaths could rise during a future pandemic through superimposed bacterial infections, inappropriate antibiotic use and reduced focus on preventing MRO infections. Methods In the state of Queensland, Australia with a population of 5 million, only a short first wave of coronavirus cases occurred and restrictions were quickly scaled back. This presented a natural experiment of pre-, during and post-COVID-19 restriction timings to evaluate the effectiveness of heightened prevention measures on multidrug resistant organism (MRO) infections. Patient isolation days and MRO types were collected weekly from routine infection control reports, at a large public hospital, from 28 th January 2020 to 24 th July 2020. In this interrupted time series design, we employed Poisson mixed effect regression modelling to evaluate the difference in incidence of patient isolation days between time periods. Results Compared to pre-COVID, patient isolation days reduced during COVID restrictions (incidence rate ratio 0.65, 95%CI: 0.59, 0.70; p<0.001) and increased again post-COVID restrictions, but did not return to pre-COVID levels (0.87, 95%CI: 0.80, 0.95; p=0.001). The efficiency of isolating patients improved after COVID-19 with fewer bed closures required. Conclusion Heightened infection control awareness, hand sanitation and mask wearing after COVID-19 restrictions were lifted appear to effectively prevent common hospital-acquired MRO infections.

Clinical Evidence of Pulp Revascularization in Necrosed and Immature Teeth: A Literature Review

“…Em contrapartida, quatro dos artigos analisados nesta revisão tiveram como resultados de seus estudos um decréscimo na identificação de microrganismos multirresistentes quando comparados os períodos pré-pandêmico e pandêmico (ELLIOTT et al, 2022;BENTIVEGNA et al, 2021;FU et al, 2021;KARATAS et al, 2021). Esse cenário pode ser justificado pelo fato de que ocorreu uma mudança nos hábitos sociais como o da utilização de máscaras, higienização das mãos e redução de grandes aglomerações de pessoas durante a pandemia (GALVÃO et al, 2020).…”

Epidemiology of Gram-negative bacteria during coronavirus disease 2019. What is the real pandemic?

“…The increase in MDR-GNB BSIs reported by Amarsy et al [11 ▪ ] coincided with a 131–148% increase in consumption of third-generation cephalosporins and represents one of the few studies that reported concurrent variation in antibiotic use [11 ▪ ,12 ▪ ,15,21,27,28]. Conversely, a decrease in these pathogens was recorded in mostly single centres in Australia [29], Italy [20,28], Sweden [30] and the US [31] by a magnitude of up to 20%.…”

“…Whereas Amarsy et al [11 & ], in the network of 25 hospitals in Paris similarly recorded a 3.3-and 2.7-fold increase in ESBL-producing K. pneumoniae and ampicillinase C (AmpC)-producing Enterobacterales BSIs/100 hospitalised patients, respectively, other studies did not show any significant differences between pre and post pandemic periods [13 ] coincided with a 131-148% increase in consumption of third-generation cephalosporins and represents one of the few studies that reported concurrent variation in antibiotic use [11 ,12 & ,15,21,27,28]. Conversely, a decrease in these pathogens was recorded in mostly single centres in Australia [29], Italy [20,28], Sweden [30] and the US [31] by a magnitude of up to 20%.…”

“…Modification of carbapenem-resistant Enterobacterales (CRE)/carbapenemase-producing Enterobacterales (CPE) rates prior to and during the pandemic has been the focus of many global studies. Despite the inclusion of a wide range of different target populations, measurements and end points, except for a few studies which showed no significant differences [19,21,32], and one which showed a significant decrease in the number of CRE/CPE isolation days [29], by far the majority of studies reported an increase in CRE/CPE rates [9]. This ranged from an increase in CRE rates from 6% in Turkey [18], 35% in the US [26] to 54% in Italy [33] and also definitive changes in Brazilian ICUs, where according to trend analysis, the monthly incidence density of CRE per 1000 PDs showed a gradual increase [12 & ].…”

Radiology Department: A Potential Source of Multidrug-Resistant Microorganisms: A Cross-Sectional Study at Tertiary Hospital, Palestine

“…The presence of MDR bacteria within hospital settings poses a significant threat that extends to the selection of empiric antibiotics that target MDR bacteria. This can perpetuate a vicious cycle of increasing antimicrobial resistance [ 2 , 10 , 11 ].…”