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. 2023 Feb;44(2):284-290.
doi: 10.1017/ice.2022.65. Epub 2022 Mar 18.

Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study

Ana Paula M Porto  1 , Igor C Borges  2 , Lewis Buss  2 , Anna Machado  3 , Bil R Bassetti  4 , Brunno Cocentino  5 , Camila S Bicalho  6 , Claudia M D M Carrilho  7 , Cristhieni Rodrigues  8 , Eudes A S Neto  9 , Evelyne S Girão  10   11   12 , Filipe Piastrelli  13 , Giovanna Sapienza  14 , Glaucia Varkulja  15 , Karin Kolbe  16 , Luciana Passos  17 , Patricia Esteves  18 , Pollyana Gitirana  19 , Regia D F Feijó  20 , Rosane L Coutinho  21 , Thais Guimarães  22 , Tiago L L Ferraz  23 , Anna S Levin  1 , Silvia F Costa  1   2 ; HAI/COVID-19 Brazilian Task Force
Affiliations

Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study

Ana Paula M Porto et al. Infect Control Hosp Epidemiol. 2023 Feb.

Abstract

Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs).

Methods: In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD).

Results: We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44-4.20) vs 2.81 (IQR, 1.35-6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin-tazobactam, meropenem, or vancomycin consumption between the studied periods.

Conclusions: There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.

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Figures

Fig. 1.
Fig. 1.
Total number of admissions (line) and number of COVID-19 admissions (bars) to the intensive care unit of 20 Brazilian hospitals from February 2020 through June 2020.
Fig. 2.
Fig. 2.
Total number of patients admitted (A), patient days (B), central-line days (C), CLABSIs (D), ventilator days (E), and VAP cases (F) in the intensive care units of 21 Brazilian hospitals between February–June 2019 and February–June 2020.
Fig. 3.
Fig. 3.
Variation in CLABSI incidence density (A) and in VAP incidence density (B) in the ICUs of 21 Brazilian hospitals between April–June 2019 and April–June 2020.
See this image and copyright information in PMC

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