The impact of the COVID-19 pandemic on healthcare-associated infections in intensive care unit patients: a retrospective cohort study

Abstract

Background During the intensive care units’ (ICUs) reorganization that was forced by the COVID-19 emergency, attention to traditional infection control measures may have been reduced. Nevertheless, evidence on the effect of the COVID-19 pandemic on healthcare-associated infections (HAIs) is still limited and mixed. In this study, we estimated the pandemic impact on HAI incidence and investigated the HAI type occurring in COVID-19 patients. Methods Patients admitted to the main ICU of the Umberto I teaching hospital of Rome from March 1st and April 4th 2020 were compared with patients hospitalized in 2019. We assessed the association of risk factors and time-to-first event through multivariable Fine and Grey’s regression models, that consider the competitive risk of death on the development of HAI (Model 1) or device related-HAI (dr-HAI, Model 2) and provide estimates of the sub-distribution hazard ratio (SHR) and its associated confidence interval (CI). A subgroup analysis was performed on the 2020 cohort. Results Data from 104 patients were retrieved. Overall, 59 HAIs were recorded, 32 of which occurred in the COVID-19 group. Patients admitted in 2020 were found to be positively associated with both HAI and dr-HAI onset (SHR: 2.66, 95% CI 1.31–5.38, and SHR: 10.0, 95% CI 1.84–54.41, respectively). Despite being not confirmed at the multivariable analysis, a greater proportion of dr-HAIs seemed to occur in COVID-19 patients, especially ventilator-associated pneumonia, and catheter-related urinary tract infections. Conclusions We observed an increase in the incidence of patients with HAIs, especially dr-HAIs, mainly sustained by COVID-19 patients. A greater susceptibility of these patients to device-related infections was hypothesized, but further studies are needed.

Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients

“…The most common bacteria with multiple genome copies were S. aureus , H. influenzae and Moraxella catarrhalis [ 19 ]. In Italy, the prevalence of HAIs among COVID-19 patients was 56.73% [ 20 ]. However, a study conducted in Germany reported 34% of bacterial co-infections [ 21 ].…”

Impact of dry hydrogen peroxide on hospital-acquired infection at a pediatric oncology hospital

“…There were COVID positive patients admitted to the PICU and IMCU; however, our study showed a reduction in HAI in the PICU in contrast to reports from the US and other countries. [32][33][34] Reports from these countries did not indicate the use of continuously-operating adjunct technology for environmental cleaning and disinfection.…”

Clostridioides difficile infection (CDI) during the COVID-19 pandemic

“…Despite improvement of prevention and control strategies, some single-center studies have observed an increase in HA-CDI cases during the COVID-19 pandemic [ 42 , 54 , 55 ] ( Table 1 ). In the study of Sandhu et al, conducted in a hospital of Michigan, USA, the rate of CDI increased from 3.32/10,000 patient-days during January–February 2020 to 3.6/10,000 patient-days during March–April 2020.…”

“…Nevertheless, some factors may contribute to the exposure of COVID-19 patients to a higher risk of CDI, as highlighted in a recent study conducted in an Italian hospital, in which, although the total CDI incidence was not significantly changed compared with the pre-pandemic period, a higher CDI incidence was observed in COVID-19 wards compared with that observed in COVID-19 free wards [ 35 ]. In this regard, it is notable that COVID-19 seems to have adversely affected some HAIs and, in particular, increased incidence rates for device-related HAIs have been reported in COVID-19 patients [ 28 , 33 , 55 , 58 , 59 ] ( Table 1 ). The growing burden of HAIs different from CDI, may indirectly favor CDI occurrence due to worsening of the patient's condition, prolongation of hospitalization and possible repeated antibiotics treatments.…”