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Observational Study
. 2023 Jul;49(7):796-807.
doi: 10.1007/s00134-023-07109-5. Epub 2023 Jun 16.

Relationship between COVID-19 and ICU-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter before-after study

Louis Kreitmann  1   2 , Sonia Jermoumi  1 , Margot Vasseur  1 , Myriam Chabani  2 , Emilie Nourry  2 , Jean-Christophe Richard  3 , Florent Wallet  4   5 , Pierre Garçon  6 , Safaâ Kachmar  6 , Yoann Zerbib  7 , Nicolas Van Grunderbeeck  8 , Christophe Vinsonneau  9 , Alain Duhamel  10 , Julien Labreuche  10 , Saad Nseir  11   12
Affiliations
Observational Study

Relationship between COVID-19 and ICU-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter before-after study

Louis Kreitmann et al. Intensive Care Med. 2023 Jul.

Abstract

Purpose: Patients presenting the most severe form of coronavirus disease 2019 (COVID-19) pneumonia, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have a prolonged intensive care unit (ICU) stay and are exposed to broad-spectrum antibiotics, but the impact of COVID-19 on antimicrobial resistance is unknown.

Methods: Observational prospective before-after study in 7 ICUs in France. All consecutive patients with an ICU stay > 48 h and a confirmed SARS-CoV-2 infection were included prospectively and followed for 28 days. Patients underwent systematic screening for colonization with multidrug-resistant (MDR) bacteria upon admission and every week subsequently. COVID-19 patients were compared to a recent prospective cohort of control patients from the same ICUs. The primary objective was to investigate the association of COVID-19 with the cumulative incidence of a composite outcome including ICU-acquired colonization and/or infection related to MDR bacteria (ICU-MDR-col and ICU-MDR-inf, respectively).

Results: From February 27th, 2020 to June 2nd, 2021, 367 COVID-19 patients were included, and compared to 680 controls. After adjustment for prespecified baseline confounders, the cumulative incidence of ICU-MDR-col and/or ICU-MDR-inf was not significantly different between groups (adjusted sub-hazard ratio [sHR] 1.39, 95% confidence interval [CI] 0.91-2.09). When considering both outcomes separately, COVID-19 patients had a higher incidence of ICU-MDR-inf than controls (adjusted sHR 2.50, 95% CI 1.90-3.28), but the incidence of ICU-MDR-col was not significantly different between groups (adjusted sHR 1.27, 95% CI 0.85-1.88).

Conclusion: COVID-19 patients had an increased incidence of ICU-MDR-inf compared to controls, but the difference was not significant when considering a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.

Trial registration: ClinicalTrials.gov NCT04378842.

Keywords: Antimicrobial resistance; COVID-19; Cross infection; Intensive care unit; Patient isolation.

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References

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