Trend analysis of carbapenem-resistant Gram-negative bacteria and antimicrobial consumption in the post-COVID-19 era: an extra challenge for healthcare institutions

Abstract

The incidence density trend of the carbapenem-resistant Gram-negative bacteria was analysed in device-associated infections and antimicrobial consumption in 99 critical care facilities in a low/middle-income country, between January 2019 and December 2020. Carbapenem-resistant Acinetobacter baumannii (CRAB) per 1000 patient-days increased in 2020 and this finding had a strong positive correlation with the incidence density of COVID-19 by the Spearman test. Polymyxin consumption also increased in 2020 but without significant correlation with CRAB or COVID-19 incidence density, presumably due to empirical and untargeted prescribing as a consequence of concern about CRAB infections. These findings are a warning to infection control programmes and antimicrobial stewardship.

Keywords: Acinetobacter baumannii; Antimicrobial drug resistance; COVID-19; Carbapenems; Healthcare-associated infections; Polymyxins.

Figure 1

Trend analysis for incidence density of CRAB, VAP, and PolyB consumption in DDD per 1000 patient-days concerning COVID-19 cases in AICU, Paraná, Brazil, 2019–2020. (A) Trend analysis for CRAB per 1000 patient-days (April 2020 to December 2020: MPC: 14.2; 95% CI: 10.1–18.5; P < 0.001). (B) Trend analysis for PolyB DDD per 1000 patient-days (July 2020 to December 2020: MPC: 17.5; 95% CI: 4.6–31.9; P = 0.009). (C) Trend analysis for VAP/1000 mv-days (November 2019 to December 2020: MPC: 2.1; 95% CI: 1.2–2.9; P < 0.001). (D) Confirmed COVID-19 cases per 1000 patient-days in AICU. AICU, adult intensive care unit; CRAB, carbapenem-resistant A. baumannii; CI, confidence interval; DDD, defined daily dose; PolyB, polymyxin B; MPC, monthly percent change; VAP, ventilator-associated pneumonia; pt, patient.