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. 2023 Jun 13:78:100231.
doi: 10.1016/j.clinsp.2023.100231. eCollection 2023.

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance

Maristela Pinheiro Freire  1 , Denise Brandão de Assis  2 , Bruno de Melo Tavares  1 , Valquiria O C Brito  3 , Igor Marinho  4 , Milton Lapchik  3 , Ana Rubia Guedes  1 , Geraldine Madalosso  2 , Maura Salaroli Oliveira  5 , Antonio Carlos Pedroso de Lima  6 , Anna S Levin  7
Affiliations

Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance

Maristela Pinheiro Freire et al. Clinics (Sao Paulo). .

Abstract

Background: This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period.

Methods: This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models.

Results: 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs.

Conclusions: HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Keywords: Antimicrobial consumption; Bloodstream infection; COVID-19; Multidrug-resistance; Pneumonia.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
(A) Central-Line-Associated Bloodstream Infections (CLABSI) rates for intensive care units, City of São Paulo, Brazil, 2017‒2021; (B) CLABSI rates according to the type of funding of the hospitals; (C) CLSI rates according to the number of hospital beds; (D) CLABSI rates according to Central Line (CL) utilization rates (Dots represent the observed CLABSI rates and lines represent the adjusted rates).
Fig 2
Fig. 2
(A) Ventilator-Associated Pneumonia (VAP) rates for intensive care units, City of São Paulo, Brazil, 2017‒2021; (B) VAP rates according to the type of funding of the hospital; (C) VAP rates according to the number of hospital beds; (D) VAP rates according to Mechanical Ventilator (MV) utilization rates (Dots represent the observed CLABSI rates and lines represent the adjusted rates).
See this image and copyright information in PMC

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