The Acquisition of Multidrug-Resistant Bacteria in Patients Admitted to COVID-19 Intensive Care Units: A Monocentric Retrospective Case Control Study

Abstract

Whether the risk of multidrug-resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is modified by the COVID-19 crisis is unknown. In this single center case control study, we measured the rate of MDRB acquisition in patients admitted in COVID-19 ICU and compared it with patients admitted in the same ICU for subarachnoid hemorrhage (controls) matched 1:1 on length of ICU stay and mechanical ventilation. All patients were systematically and repeatedly screened for MDRB carriage. We compared the rate of MDRB acquisition in COVID-19 patients and in control using a competing risk analysis. Of note, although we tried to match COVID-19 patients with septic shock patients, we were unable due to the longer stay of COVID-19 patients. Among 72 patients admitted to the COVID-19 ICUs, 33% acquired 31 MDRB during ICU stay. The incidence density of MDRB acquisition was 30/1000 patient days. Antimicrobial therapy and exposure time were associated with higher rate of MDRB acquisition. Among the 72 SAH patients, 21% acquired MDRB, with an incidence density was 18/1000 patient days. The septic patients had more comorbidities and a greater number of previous hospitalizations than the COVID-19 patients. The incidence density of MDRB acquisition was 30/1000 patient days. The association between COVID-19 and MDRB acquisition (compared to control) risk did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93–3.21)). Thus, we conclude that, despite strong physical isolation, acquisition rate of MDRB in ICU patients was at least similar during the COVID-19 first wave compared to previous period.

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

“…Similar to our study, no changes in detection of Enterococcus faecium infections were identified during COVID-19 restrictions. Also similar to our findings, in a Belgian study, no differences in the acquisition rate of MROs in the intensive care unit (ICU) were found before and during the COVID-19 pandemic [ 9 ]. This may be explained by the heightened prevention measures already occurring for patients within an ICU.…”

Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards

“…Intensive care unit studies in Italy demonstrated an increase in the rate of infections by Klebsiella carbapenemase-resistant, E. coli , and Enterococcus spp., but these studies considered both COVID-19 and no COVID-19 patients [ 24 , 25 ]. Conversely, in a Spanish study carried out in a tertiary hospital for 20 weeks before and during the COVID-19 spread, the mean incidence density of blood infections caused by MDR organisms remained stable, with a value of 0.36 ± 0.42 cases per 1000 occupied bed days in the COVID-19 period and 0.33 ± 0.28 bloodstream infections per 1000 occupied bed days in the period before the national lockdown [ 26 ].…”

Implications of COVID-19 Pandemic on the Emergence of Antimicrobial Resistance: Adjusting the Response to Future Outbreaks

“…Reports from ICUs indicate the incidence or resistant infection acquisition at 30/1000 patients-day. The data shows that, of 72 patients, 33% acquired 31 multidrug-resistant bacteria during their stay at the ICU [ 67 ]. These high rates of acquisition of multiresistant infections may be explained with the work overload and ICU overcrowding, as well as a decreased adherence to control measures and shortages of personal protective equipment [ 25 , 27 , 28 , 51 , 68 ].…”