The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

Background: Whether the risk of multidrug resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is increased during the COVID-19 crisis is unknown. Our aim was to measure the rate of MDRB acquisition in patients admitted in COVID-19 ICU and to compare it with pre-COVID-19 controls.Methods: This single center case control study included adult patients admitted to COVID-19 ICUs for more than 48h. Patients were screen twice a week for MDRB carriage during ICU stay. We compared the rate of MDRB acquisition of COVID-19 patients with a cohort of patients admitted for subarachnoid hemorrhage (SAH) and matched on length of ICU stay using a competing risk analysis.Results: Among 72 patients admitted to the COVID-19 ICUs, 24 (33%) patients acquired 31 MDRB during ICU stay. The rate of MDRB acquisition was 30/1000 patient-days. Patients that acquired MDRB had received more antimicrobial therapy [22 (92%) vs 34 (78%, p=0.05] and had a longer exposure time [12 days (8-18) vs 5 days (2-18), p=0.02]. The rate of MDRB acquisition in matched SAH patients was 18/1000 patient-days. When compared to SAH retrospective cohort, being admitted to a COVID-19 ICU was associated with a numerically higher proportion of MDRB acquisition. This association did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21).Conclusion: Acquisition of MDRB was frequent during the COVID-19 first wave in ICU patients. Despite physical isolation, it was similar to patients admitted to the same ICU in previous years.

[1]  M. Cotter,et al.  Severe COVID-19 and healthcare-associated infections on the ICU: time to remember the basics? , 2020, Journal of Hospital Infection.

[2]  L. Mbuagbaw,et al.  COVID-19 and Antimicrobial Resistance: Parallel and Interacting Health Emergencies , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  J. Gu,et al.  Assistance Publique–Hôpitaux de Paris' response to the COVID-19 pandemic , 2020, The Lancet.

[4]  F. Martinez,et al.  Respiratory Mechanics and Gas Exchange in COVID-19–associated Respiratory Failure , 2020, Annals of the American Thoracic Society.

[5]  F. Davies,et al.  COVID-19 and the potential long-term impact on antimicrobial resistance , 2020, The Journal of antimicrobial chemotherapy.

[6]  A. Murray,et al.  The Novel Coronavirus COVID-19 Outbreak: Global Implications for Antimicrobial Resistance , 2020, Frontiers in Microbiology.

[7]  G. Cooke,et al.  Bacterial and fungal co-infection in individuals with coronavirus: A rapid review to support COVID-19 antimicrobial prescribing , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  Peter D Sullivan,et al.  Facial protection for healthcare workers during pandemics: a scoping review , 2020, BMJ Global Health.

[9]  M. Lipsitch,et al.  Estimated Demand for US Hospital Inpatient and Intensive Care Unit Beds for Patients With COVID-19 Based on Comparisons With Wuhan and Guangzhou, China , 2020, JAMA network open.

[10]  C. Clancy,et al.  COVID-19, superinfections and antimicrobial development: What can we expect? , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  Andrew E. Williams,et al.  An international characterisation of patients hospitalised with COVID-19 and a comparison with those previously hospitalised with influenza , 2020, medRxiv.

[12]  Megan L Ranney,et al.  Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. , 2020, The New England journal of medicine.

[13]  J. Xiang,et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study , 2020, The Lancet.

[14]  J. D. De Waele,et al.  Multidrug-resistant bacteria in ICU: fact or myth. , 2020, Current opinion in anaesthesiology.

[15]  Lucy Reynolds,et al.  The Role of Antimicrobial Restrictions in Bacterial Resistance Control: A Systematic Literature Review. , 2020, The Journal of hospital infection.

[16]  Antibiotic resistance threats in the United States, 2019 , 2019 .

[17]  S. Kernéis,et al.  Controlling the Diffusion of Multidrug-Resistant Organisms in Intensive Care Units , 2019, Seminars in Respiratory and Critical Care Medicine.

[18]  J. Rodríguez-Baño,et al.  Current options for the treatment of infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. , 2019, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[19]  F. Bilotta,et al.  Cerebrospinal Fluid Glucose and Lactate Levels After Subarachnoid Hemorrhage: A Multicenter Retrospective Study , 2019, Journal of neurosurgical anesthesiology.

[20]  F. Charbel,et al.  Reducing length of stay in aneurysmal subarachnoid hemorrhage: A three year institutional experience , 2017, Journal of Clinical Neuroscience.

[21]  B. Gadeyne,et al.  Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study , 2016, Intensive Care Medicine.

[22]  S. Cosgrove,et al.  Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum , 2013, Antimicrobial Resistance and Infection Control.

[23]  R. Macdonald,et al.  Early Predictors of Prolonged Stay in a Critical Care Unit Following Aneurysmal Subarachnoid Hemorrhage , 2013, Neurocritical Care.

[24]  M. Falagas,et al.  Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. , 2012, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[25]  Dirk Vogelaers,et al.  The rising problem of antimicrobial resistance in the intensive care unit , 2011, Annals of intensive care.

[26]  Anthony S Fauci,et al.  Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. , 2008, The Journal of infectious diseases.

[27]  M. Osterholm,et al.  Preparing for the next pandemic. , 2005, The New England journal of medicine.

[28]  Didier Pittet,et al.  Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. , 2002, American journal of infection control.

[29]  H. Grundmann,et al.  Detection of cross-transmission of multiresistant Gram-negative bacilli and Staphylococcus aureus in adult intensive care units by routine typing of clinical isolates. , 1999, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[30]  P. Chetchotisakd,et al.  Assessment of bacterial cross-transmission as a cause of infections in patients in intensive care units. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.