Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital

Farid Zand; Hedayatollah Vakili; Naeimehossadat Asmarian; Mansoor Masjedi; Golnar Sabetian; Reza Nikandish; Elham Shafiee; Azita Tabatabaei Esfehani; Fatemeh Azadi; Anahita Sanaei Dashti

doi:10.1186/s12879-022-07962-7

Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital

BMC Infect Dis. 2023 Jan 6;23(1):11. doi: 10.1186/s12879-022-07962-7.

Affiliations

¹ Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
² Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
⁴ Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. anahitasanaei@gmail.com.

Abstract

Background: The prevalence of resistant hospital infections in the intensive care unit (ICU) increases mortality and antibiotic resistance. COVID-19 pandemic may have unintended impact on nosocomial infections (NI) and the prevalence of resistant microorganism.

Methodology: The present non-interventional study was performed by a pre and a post survey each lasting 8 months before (March-October 2019) and after (March-October 2020) the onset of COVID-19 pandemic in three ICU's, not allocated to COVID-19 patients, in Nemazee Hospital, Shiraz, Iran. The rates of the following nosocomial infections were compared at pre- and post-pandemic period: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and incidence of multiple drug resistance (MDR) pathogens.

Results: Pre-pandemic and pandemic incidence of VAP was 23.5 and 17.2 cases per 1000 device-days, respectively; an absolute decrease of 27%. The main reason for the decrease in the rate of VAP during the pandemic was a significant decrease in the rate of VAP caused by Acinetobacter baumannii; from 39 to 17% in total VAP episodes. The rate of VAP associated with other microorganisms remained relatively unchanged from 14.2 cases in pre-pandemic period to 14.3 cases per 1000 MV-days during the pandemic (P = 0.801). Pre-pandemic incidence of CLABSI was 7.3 cases and, in pandemic period, was 6.5 cases per 1000 device-days (IRR = 0.88, 95% CI 0.43-1.73, P = 0.703). Pre-pandemic incidence of CAUTI was 2 and in pandemic period, was 1.4 cases per 1000 device-days (IRR = 0.70, 95% CI 0.22-1.98, P = 0.469).

Conclusion: The results of the present study showed a decrease in the incidence of VAP in critically ill non-COVID-19 patients during the pandemic compared to before the pandemic, especially regarding Acinetobacter baumannii.

Keywords: COVID-19; Catheter-associated urinary tract infections (CAUTI); Central line associated blood stream infection (CLABSI); Intensive care unit (ICU); Multiple drug resistance (MDR); Nosocomial infection (NI); Ventilator associated pneumonia (VAP).

MeSH terms

Acinetobacter baumannii*
COVID-19* / epidemiology
Catheter-Related Infections* / epidemiology
Catheters
Cross Infection* / epidemiology
Drug Resistance, Multiple
Hospitals, Teaching
Humans
Incidence
Intensive Care Units
Pandemics
Pneumonia, Ventilator-Associated* / epidemiology
Prospective Studies
Urinary Tract Infections* / epidemiology