Surging bloodstream infections and antimicrobial resistance during the first wave of COVID–19: a study in a large multihospital institution in the Paris region

Amarsy, Rishma; Monteil, Catherine; Fournier, Sandra; Oliary, J.; Junot, Helga; Sabatier, Pierre; Porcher, Raphaël; Arlet, Guillaume; Lefèvre, Lise; Aubry, Alexandra; Bélec, Laurent; Berçot, Béatrice; Bonacorsi, Stéphane; Cálvez, Vincent; Cambau, Emmanuelle; Carbonnelle, Étienne; Chevaliez, Stéphane; Decousser, Jean‐Winoc; Delaugerre, Constance; Descamps, Diane; Doucet‐Populaire, Florence; Gaillard, Jean‐Louis; Chenon, Antoine Garbarg-; Gault, Elyanne; Herrmann, Jean-Louis; Jarlier, Vincent; Goff, Jérôme Le; Lucet, Jean‐Christophe; Mainardi, Jean–Luc; Marcellin, Anne-Geneviève; Morand‐Joubert, Laurence; Nassif, Xavier; Pawlotsky, Jean‐Michel; Robert, Jérôme; Afonso, Anne-Marie Roque; Rottman, Martin; Rouzioux, Christine; Rozenberg, Flore; Simon, François; Véziris, Nicolas; Skurnik, David; Zahar, Jean‐Ralph; Barnaud, Guilène; Pomares, Typhaine Billard; Cuzon, Gaëlle; Decré, Dominique; Doloy, Alexandra; Donay, Jean-Luc; Drieux-Rouzet, Laurence; Durand, Isabelle; Ferroni, Agnès; Fihman, Vincent; Fortineau, Nicolas; Gomart, Camille; Grall, Nathalie; Caruba, Christelle Guillet; Jauréguy, Françoise; Lalande, V.; Landraud, Luce; Leflon, Véronique; Mariani, Patricia; Mihaila, Liliana; Moissenet, Didier; Noussair, Latifa; Podglajen, Isabelle; Poîlane, I.; Poupet, Hélène; Rondinaud, Emilie; Tardy, Valérie Sivadon; Trystram, David; Verdet, Charlotte; Vigier, Emmanuelle; Billarant, Sophie Vimont

doi:10.1016/j.ijid.2021.10.034

Cited by 34 publications

(34 citation statements)

References 32 publications

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“…Notwithstanding the heterogeneity of study designs, for the most part, the evidence suggests that there was a dramatic surge of BSIs, HOIs, central line associated blood stream infections (CLABSIs) and episodes of ventilator-associated pneumonia (VAP) caused by GNB, during the pandemic globally. These significant variations were generally most evident in large, system-wide regional or national hospital and surveillance networks [11 ▪ –14 ▪ ,15,16 ▪ ], and coinciding with this, was a substantial increase in one or more of the major GNB pathogens, that is K. pneumonia e (K. pneumoniae) [11 ▪ ,14 ▪ ,16 ▪ ], P. aeruginosa [11 ▪ ,14 ▪ ,16 ▪ ,17] and A. baumannii [12 ▪ ,18].…”

Section: Variation In Epidemiology Of Gram-negative Infections Before...mentioning

confidence: 88%

“…In a multicentre 25-hospital network in France, Amarsy et al [11 ▪ ] found that the rate ratio of BSIs per 100 admissions increased by 24% and 115% in March 2020 and April 2020, respectively compared to prepandemic rates, and coincided with an increase in the major GNB pathogens. In another large study, from Brazil involving ICU patients across 99 hospitals, de Carvalho Hessel Dias et al [12 ▪ ] reported increases in the incidence of both VAP and CLABSI and a significant increase in the incidence density of A. baumannii .…”

Section: Variation In Epidemiology Of Gram-negative Infections Before...mentioning

confidence: 99%

“…The CDC reported an overall 10% and for HOI, a 32% rate increase in ESBL-producing Enterobacterales [26]. 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 ▪ ,17,18]. 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].…”

Section: Variation In Antibiotic-resistant Gram-negative Infections B...mentioning

confidence: 99%

See 2 more Smart Citations

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

Brink

Richards

Tootla

et al. 2022

Current Opinion in Infectious Diseases

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Purpose of reviewBacterial infections play a key role in hospital outcomes during the coronavirus disease 2019 (COVID-19) pandemic. Nonetheless, the global impact on the epidemiology of Gram-negative bacteria (GNB) and antibiotic resistance has not been clearly established.Recent findingsMultiple limitations exist in the current literature, in that substantial variability was observed with regard to methodology. Notwithstanding the heterogeneity, the evidence suggests that the COVID-19 pandemic had a substantial negative impact on global epidemiology with an increase in hospital-onset infections, associated with GNB. Similarly, an alarming increase in resistant GNB compared to prepandemic rates, was apparent. This was most evident for carbapenemase-producing Klebsiella pneumoniae (bloodstream infections), carbapenem-resistant Pseudomonas aeruginosa (ventilator-associated pneumonia), and carbapenem-resistant Acinetobacter baumannii (all infections). Significant variations were most apparent in the large, system-wide regional or national comparative assessments, vs. single-centre studies. Categorizing concurrent bacteria as co- or secondary-infections may be paramount to optimize standard of care.SummaryThe data from most studies signal the probability that COVID-19 accelerated resistance. However, multiple limitations intrinsic to interpretation of current COVID-19 data, prevents accurately quantifying collateral damage on the global epidemiology and antibiotic resistance amongst GNB. It is likely to be substantial and renewed efforts to limit further increases is warranted.

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Section: Variation In Epidemiology Of Gram-negative Infections Before...mentioning

confidence: 88%

Section: Variation In Epidemiology Of Gram-negative Infections Before...mentioning

confidence: 99%

Section: Variation In Antibiotic-resistant Gram-negative Infections B...mentioning

confidence: 99%

See 1 more Smart Citation

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

Brink

Richards

Tootla

et al. 2022

Current Opinion in Infectious Diseases

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“…The issue of poor case ascertainment and notification could be raised to explain the decreases while countries were responding to the surge of COVID-19. However, we studied S. pneumoniae and S. pyogenes invasive infections diagnosed in the hospital setting, where an increase in the number of blood cultures collected, in particular during the first wave has been reported 12 . Hence, the reductions by 34% for S. pneumoniae and 28% for S. pyogenes observed in 2020 in our facilities are likely to be consistent with actual decreases in incidence rates.…”

Section: Discussionmentioning

confidence: 99%

Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: A time-series analysis in Paris region

Amarsy

Fournier

Monteil

et al. 2023

American Journal of Infection Control

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“…Studies could also use prospective data or data linkage that can offer important paths for future evidence. Some studies using these methods found that BSI as a whole increased in the pandemic, contamination rates increased with ICU bed surges, and any BSI increased mortality [ 18 , 22 , 43 ]. A large collection of patient data using these study methods could construct a laboratory algorithm model, similar to prediction models created for severe COVID-19 or mortality, to better predict bacterial coinfection in patients and ensure they are appropriately treated [ 44 – 48 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19

et al. 2022

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Introduction Inappropriate antibiotic use in COVID-19 is often due to treatment of presumed bacterial coinfection. Predictive factors to distinguish COVID-19 from COVID-19 with bacterial coinfection or bloodstream infection are limited. Methods We conducted a retrospective cohort study of 595 COVID-19 patients admitted between March 8, 2020, and April 4, 2020, to describe factors associated with a bacterial bloodstream coinfection (BSI). The primary outcome was any characteristic associated with BSI in COVID-19, with secondary outcomes including 30-day mortality and days of antibiotic therapy (DOT) by antibiotic consumption (DOT/1000 patient-days). Variables of interest were compared between true BSI ( n = 25) and all other COVID-19 cases ( n = 570). A secondary comparison was performed between positive blood cultures with true BSI ( n = 25) and contaminants ( n = 33) on antibiotic use. Results Fever (> 38 °C) (as a COVID-19 symptom) was not different between true BSI ( n = 25) and all other COVID-19 patients ( n = 570) ( p = 0.93), although it was different as a reason for emergency department (ED) admission ( p = 0.01). Neurological symptoms (ED reason or COVID-19 symptom) were significantly higher in the true BSI group ( p < 0.01, p < 0.01) and were independently associated with true BSI (ED reason: OR = 3.27, p < 0.01; COVID-19 symptom: OR = 2.69, p = 0.03) on multivariate logistic regression. High (15–19.9 × 10 9 /L) white blood cell (WBC) count at admission was also higher in the true BSI group ( p < 0.01) and was independently associated with true BSI (OR = 2.56, p = 0.06) though was not statistically significant. Thirty-day mortality was higher among true BSI ( p < 0.01). Antibiotic consumption (DOT/1000 patient-days) between true BSI and contaminants was not different ( p = 0.34). True bloodstream coinfection was 4.2% (25/595) over the 28-day period. Conclusion True BSI in COVID-19 was associated with neurological symptoms and nonsignificant higher WBC, and led to overall higher 30-day mortality and worse patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00636-6.

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Surging bloodstream infections and antimicrobial resistance during the first wave of COVID–19: a study in a large multihospital institution in the Paris region

Cited by 34 publications

References 32 publications

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

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

Decrease of hospital- and community-acquired bloodstream infections due to Streptococcus pneumoniae and Streptococcus pyogenes during the first year of the COVID-19 pandemic: A time-series analysis in Paris region

Clinical Characteristics Associated with Bacterial Bloodstream Coinfection in COVID-19

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