Incidence of bloodstream infections due to multidrug-resistant pathogens in ordinary wards and intensive care units before and during the COVID-19 pandemic: a real-life, retrospective observational study.
Acinetobacter
Antimicrobial resistance
COVID
Intensive care unit
MRSA
Journal
Infection
ISSN: 1439-0973
Titre abrégé: Infection
Pays: Germany
ID NLM: 0365307
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
29
12
2022
accepted:
07
02
2023
medline:
19
7
2023
pubmed:
4
3
2023
entrez:
3
3
2023
Statut:
ppublish
Résumé
SARS-COV-2 pandemic led to antibiotic overprescription and unprecedented stress on healthcare systems worldwide. Knowing the comparative incident risk of bloodstream infection due to multidrug-resistant pathogens in COVID ordinary wards and intensive care-units may give insights into the impact of COVID-19 on antimicrobial resistance. Single-center observational data extracted from a computerized dataset were used to identify all patients who underwent blood cultures from January 1, 2018 to May 15, 2021. Pathogen-specific incidence rates were compared according to the time of admission, patient's COVID status and ward type. Among 14,884 patients for whom at least one blood culture was obtained, a total of 2534 were diagnosed with HA-BSI. Compared to both pre-pandemic and COVID-negative wards, HA-BSI due to S. aureus and Acinetobacter spp. (respectively 0.3 [95% CI 0.21-0.32] and 0.11 [0.08-0.16] new infections per 100 patient-days) showed significantly higher incidence rates, peaking in the COVID-ICU setting. Conversely, E. coli incident risk was 48% lower in COVID-positive vs COVID-negative settings (IRR 0.53 [0.34-0.77]). Among COVID + patients, 48% (n = 38/79) of S. aureus isolates were resistant to methicillin and 40% (n = 10/25) of K. pneumoniae isolates were resistant to carbapenems. The data presented here indicate that the spectrum of pathogens causing BSI in ordinary wards and intensive care units varied during the pandemic, with the greatest shift experienced by COVID-ICUs. Antimicrobial resistance of selected high-priority bacteria was high in COVID positive settings.
Identifiants
pubmed: 36867310
doi: 10.1007/s15010-023-02000-3
pii: 10.1007/s15010-023-02000-3
pmc: PMC9983510
doi:
Substances chimiques
Anti-Infective Agents
0
Anti-Bacterial Agents
0
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1061-1069Informations de copyright
© 2023. The Author(s).
Références
Murray CJ, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet 2022. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext . Accessed 4 Feb 2022.
Tacconelli E, Carrara E, Savoldi A, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018;18:318–27.
doi: 10.1016/S1473-3099(17)30753-3
pubmed: 29276051
Antimicrobial resistance in the EU/EEA (EARS-Net). 2020;34.
Perez S, Innes GK, Walters MS, et al. Increase in hospital-acquired carbapenem-resistant acinetobacter baumannii infection and colonization in an acute care hospital during a surge in COVID-19 admissions—New Jersey, February–July 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1827–31.
doi: 10.15585/mmwr.mm6948e1
pubmed: 33270611
pmcid: 7714028
Langford BJ, So M, Raybardhan S, et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect. 2021;27:520–31.
doi: 10.1016/j.cmi.2020.12.018
pubmed: 33418017
pmcid: 7785281
COVID-19: US Impact on Antimicrobial Resistance, Special Report 2022. National Center for Emerging and Zoonotic Infectious Diseases, 2022. Available at: https://stacks.cdc.gov/view/cdc/117915 . Accessed 18 Nov 2022.
Rando E, Segala FV, Vargas J, et al. Cefiderocol for severe carbapenem-resistant A. baumannii Pneumonia: towards the comprehension of its place in therapy. Antibiotics. 2021;11:3.
doi: 10.3390/antibiotics11010003
pubmed: 35052880
pmcid: 8773286
Segala FV, Bavaro DF, Di Gennaro F, et al. Impact of SARS-CoV-2 epidemic on antimicrobial resistance: a literature review. Viruses. 2021;13:2110.
doi: 10.3390/v13112110
pubmed: 34834917
pmcid: 8624326
Murri R, Masciocchi C, Lenkowicz J, et al. A real-time integrated framework to support clinical decision making for COVID-19 patients. Comput Methods Programs Biomed. 2022;217: 106655.
doi: 10.1016/j.cmpb.2022.106655
pubmed: 35158181
pmcid: 8800500
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335:806–8.
doi: 10.1136/bmj.39335.541782.AD
R Core Team. R: the R project for statistical computing. Available at: https://www.r-project.org/ . Accessed 13 Oct 2022.
Billings J, Ching BCF, Gkofa V, Greene T, Bloomfield M. Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis. BMC Health Serv Res. 2021;21:923.
doi: 10.1186/s12913-021-06917-z
pubmed: 34488733
pmcid: 8419805
Wee LEI, Conceicao EP, Tan JY, et al. Unintended consequences of infection prevention and control measures during COVID-19 pandemic. Am J Infect Control. 2021;49:469–77.
doi: 10.1016/j.ajic.2020.10.019
pubmed: 33157180
Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020;8:506–17.
doi: 10.1016/S2213-2600(20)30161-2
pubmed: 32272080
pmcid: 7198848
Sieswerda E, de Boer MGJ, Bonten MMJ, et al. Recommendations for antibacterial therapy in adults with COVID-19—an evidence based guideline. Clin Microbiol Infect. 2021;27:61–6.
doi: 10.1016/j.cmi.2020.09.041
pubmed: 33010444
Lee AS, de Lencastre H, Garau J, et al. Methicillin-resistant Staphylococcus aureus. Nat Rev Dis Primer. 2018;4:18033.
doi: 10.1038/nrdp.2018.33
Munoz-Price LS, Weinstein RA. Acinetobacter infection. N Engl J Med. 2008;358:1271–81.
doi: 10.1056/NEJMra070741
pubmed: 18354105
De Pascale G, De Maio F, Carelli S, et al. Staphylococcus aureus ventilator-associated pneumonia in patients with COVID-19: clinical features and potential inference with lung dysbiosis. Crit Care Lond Engl. 2021;25:197.
doi: 10.1186/s13054-021-03623-4
Grasselli G, Scaravilli V, Mangioni D, et al. Hospital-acquired infections in critically ill patients with COVID-19. Chest. 2021;160:454–65.
doi: 10.1016/j.chest.2021.04.002
pubmed: 33857475
Langford BJ, So M, Leung V, et al. Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression. Clin Microbiol Infect 2021. Available at: https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(21)00636-4/fulltext . Accessed 17 Feb 2022.
Durán-Manuel EM, Cruz-Cruz C, Ibáñez-Cervantes G, et al. Clonal dispersion of Acinetobacter baumannii in an intensive care unit designed to patients COVID-19. J Infect Dev Ctries. 2021;15:58–68.
doi: 10.3855/jidc.13545
pubmed: 33571146