Device-Associated Infections in COVID-19 Patients: Frequency of Resistant Bacteria, Predictors and Mortality in Medellín, Colombia

Abstract

Introduction: Increased antimicrobial use during the COVID-19 pandemic has raised concerns about the spread of resistant bacteria. This study analyzed the frequency of device-associated infections (DAI) caused by resistant bacteria, the predictors of these infections, and 30-day all-cause mortality in patients with and without COVID-19.

Methods: A retrospective cohort study was conducted on DAI patients admitted to the ICU (intensive care unit) in 20 hospitals in Medellin, Colombia (2020-2021). The exposure assessed was the COVID-19 diagnosis, and outcomes analyzed were resistant bacterial infections and 30-day mortality. Clinical and microbiological information was collected from surveillance databases. Statistical analysis included generalized linear mixed-effects models.

Results: Of the 1521 patients included, 1033 (67.9%) were COVID-19-positive and 1665 DAI were presented. Carbapenem-resistant Enterobacteriaceae (CRE) infections predominated during the study (n = 98; 9.9%). The patients with COVID-19 had a higher frequency of metallo-beta-lactamase-producing CRE infections (n = 15; 33.3%) compared to patients without the disease (n = 3; 13.0%). Long-stay in the ICU (RR: 2.09; 95% CI: 1.39-3.16), diabetes (RR: 1.73; 95% CI: 1.21-2.49), and mechanical ventilation (RR: 2.13; 95% CI: 1.01-4.51) were CRE infection predictors in COVID-19 patients, with a mortality rate of 60.3%.

Conclusion: CRE infections were predominant in COVID-19 patients. In pandemic situations, the strategies to control DAI should be maintained to avoid infections caused by resistant bacteria, such as length of stay in the ICU and duration of mechanical ventilation.

Keywords: COVID-19; bacterial resistance; carbapenemases; device-associated infections; healthcare-associated infections.

Figure 1

COVID-19 cases and resistant microorganisms causing device-associated infections in Medellín between March 2020 and May 2021. (A) Infections caused by at least one resistant microorganism (methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., Gram-negative bacteria producing ESBLs, or carbapenem-resistant Gram-negative bacteria). Data from WHONET; (B) COVID-19 peaks in Medellín (between July and August 2020, between October and November 2020, January 2021, and between April and May 2021). Data from National Institute of Health, Colombia.

Figure 2

Frequency of resistant microorganisms according to the diagnosis of COVID-19. MRSA: methicillin-resistant Staphylococcus aureus; VRE: vancomycin-resistant Enterococcus spp.; CRE: carbapenem-resistant Enterobacteriaceae; carbapenem-resistant non-fermenting Gram-negative bacilli (CRNF-GNB); and ESBL-producing Gram-negative bacilli (ESBL-GNB).

Figure 3

Relationship between COVID-19 cases and mortality. The size of the bubble is proportional to the number of deaths caused by each resistant bacterium. (A) VAP: ventilator-associated pneumonia; (B) CAUTI: catheter-associated urinary tract infection; (C) CLABSI: central-line-associated bloodstream infection. MRSA: methicillin-resistant Staphylococcus aureus, VRE: vancomycin-resistant Enterococcus spp.; CRE: carbapenem-resistant Enterobacteriaceae, carbapenem-resistant non-fermenting Gram-negative bacilli (CRNF-GNB), and ESBL-producing Gram-negative bacilli (ESBL-GNB).

Figure 3

Relationship between COVID-19 cases and mortality. The size of the bubble is proportional to the number of deaths caused by each resistant bacterium. (A) VAP: ventilator-associated pneumonia; (B) CAUTI: catheter-associated urinary tract infection; (C) CLABSI: central-line-associated bloodstream infection. MRSA: methicillin-resistant Staphylococcus aureus, VRE: vancomycin-resistant Enterococcus spp.; CRE: carbapenem-resistant Enterobacteriaceae, carbapenem-resistant non-fermenting Gram-negative bacilli (CRNF-GNB), and ESBL-producing Gram-negative bacilli (ESBL-GNB).