The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Risk of Death, OR (95% CI) | Risk of Prolonged Hospital Stay, OR (95% CI) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
2018 | 2019 | 2020 | 2021 | 2022 | 2018 | 2019 | 2020 | 2021 | 2022 | |
Acinetobacter baumannii Carvapenem resistant | 3.6 (2.1–4.5) n = 145 | 3.5 (2.4–5.1) n = 136 | 3.9 (3.1–6.1) n = 125 | 4.1 (3.4–6.1) n = 162 | 4.2 (3.5–5.2) n = 174 | 7.6 (5.3–9.5) n = 145 | 7.8 (6.2–9.2) n = 136 | 7.9 (7.2–9.4) n = 125 | 7.8 (6.9–9.2) n = 162 | 8.2 (7.6–10.1) n = 174 |
Acinetobacter baumannii Non Carvapenem resistant | 2.1 (1.4–2.8) n = 44 | 2.2 (1.5–2.7) n = 38 | 2.4 (1.8–3.1) n = 33 | 2.3 (1.7–2.9) n = 20 | 2.4 (1.6–2.9) n = 26 | 4.3 (3.9–5.4) n = 44 | 4.5 (3.8–5.9) n = 38 | 4.3 (3.7–5.4) n = 33 | 4.4 (3.9–5.8) n = 20 | 4.5 (3.7–5.3) n = 26 |
Klebsiella pneumoniae Carvapenem resistant | 3.1 (2.4–5.1) n = 98 | 3.3 (2.2–5.1) n = 109 | 3.6 (2.8–5.7) n = 106 | 3.5 (2.9–4.3) n = 110 | 3.8 (2.6–4.1) n = 126 | 6.5 (5.4–7.9) n = 98 | 6.7 (5.6–8.4) n = 109 | 6.7 (6.2–8.6) n = 106 | 6.9 (5.9–7.8) n = 110 | 7.1 (6.5–8.9) n = 126 |
Klebsiella pneumoniae Non Carvapenem resistant | 2.2 (1.4–2.8) n = 46 | 1.9 (1.3–2.7) n = 38 | 2.1 (1.6–2.9) n = 40 | 2.2 (1.5–3.1) n = 36 | 2.3 (1.6–2.8) n = 30 | 3.1 (2.7–4.2) n = 46 | 3.3 (2.7–4.5) n = 38 | 3.4 (2.8–4.7) n = 40 | 3.5 (2.7–4.9) n = 36 | 3.5 (2.8–4.8) n = 30 |
Pseudomonas aeruginosa MDR, Multidrug resistant | 3.1 (2.4–4.7) n = 87 | 3.4 (2.4–4.9) n = 121 | 3.8 (2.4–5.9) n = 101 | 3.7 (2.9– 2.8) n = 131 | 3.9 (3.1–4.3) n = 129 | 5.6 (4.6–7.3) n = 87 | 5.8 (4.5–7.9) n = 121 | 5.9 (4.5–7.2) n = 101 | 6.4 (5.9–7.3) n = 131 | 6.5 (4.9–8.2) n = 129 |
Pseudomonas aeruginosa Non MDR, Non Multidrug resistant | 1.9 (1.3–3.7) n = 31 | 2.0 (1.4–3.8) n = 30 | 2.1 (1.5–3.7) n = 35 | 2.1 (1.6–3.9) n = 43 | 2.2 (1.7–3.8) n = 40 | 3.2 (2.8–4.3) n = 31 | 3.3 (2.7–4.9) n = 30 | 2.9 (2.6–4.5) n = 35 | 3.0 (2.4–4.2) n = 43 | 3.1 (2.6–4.9) n = 40 |
Enterococcus faecium VRE, Vancomycin resistant | 1.4 (0.9–1.8) n = 8 | 1.6 (1.1–3.6) n = 12 | 1.6 (1.2–3.4) n = 15 | 1.9 (1.1– 2.2) n = 17 | 2.1 (1.7–2.9) n = 18 | 3.9 (3.1–5.3) n = 8 | 3.8 (3.1–5.7) n = 12 | 4.2 (3.6–6.3) n = 15 | 4.6 (4.5–7.6) n = 17 | 4.8 (4.1–7.3) n = 18 |
Enterococcus faecium Non VRE, Non Vancomycin resistant | 1.1 (0.7–1.7) n = 27 | 1.2 (0.7–2.1) n = 29 | 1.3 (0.8–2.4) n = 32 | 1.4 (0.9–2.6) n = 30 | 1.4 (0.9–2.5) n = 36 | 2.5 (1.9–3.8) n = 27 | 2.6 (2.1–3.9) n = 29 | 2.5 (1.8–3.7) n = 32 | 2.7 (2.0–3.9) n = 30 | 2.6 (1.9–3.7) n = 36 |
Staphylococcus aureus MRSA, Methicillin resistant | 3.0 (2.1–4.9) n = 48 | 3.0 (2.2–4.7) n = 41 | 3.1 (2.3– 4.5) n = 52 | 3.2 (2.4–4.1) n = 59 | 3.4 (2.8–4.9) n = 55 | 2.3 (2.1–4.6) n = 48 | 2.3 (2.1–4.3) n = 41 | 2.4 (2.1–4.1) n = 52 | 2.4 (1.8–4.3) n = 59 | 2.6 (2.2–5.1) n = 55 |
Staphylococcus aureus Non MRSA, Non Methicillin resistant | 1.7 (0.8–2.6) n = 95 | 1.6 (0.9–2.6) n = 90 | 1.6 (1.0–2.6) n = 90 | 1.8 (1.1–2.9) n = 98 | 1.8 (1.0–2.8) n = 90 | 2.1 (1.4–3.5) n = 95 | 2.2 (1.4–3.7) n = 90 | 2.3 (1.6–3.7) n = 90 | 2.3 (1.5–3.8) n = 98 | 2.4 (1.5–3.9) n = 90 |
p-value < 0.001 | p-value < 0.001 |
Pre-Pandemic Period 2018–2019 (n = 246) Group A | COVID-19 Pandemic 2020–2022 (n = 154) Group B | |
---|---|---|
Gender, male | 166 (67.2%) | 98 (63.6%) |
Age, years, mean ± SD | 65.6 (50.4–76.4) | 65.8 (50.5–77.4) |
Duration of bacteraemia symptoms before treatment initiation | ||
0–24 h | 158 (64.2%) | 73 (47.4%) |
25–72 h | 25 (10.2%) | 34 (22.1%) |
>72 h | 55 (22.4%) | 36 (23.4%) |
Unknown | 8 (3.2%) | 11 (7.1%) |
Telephone consultation | 37 (15%) | 117 (76%) |
Bedside consultation | 209 (85%) | 37 (24%) |
Group A, 2018–2019 (n = 246) | Group B, 2020–2022 (n = 154) | p-Value | |
---|---|---|---|
Operation within 30 days | 34 (13.8%) | 29 (18.8%) | 0.04 |
Diabetes mellitus type 2 | 89 (36.2%) | 68 (44.2%) | 0.12 |
Heart failure | 26 (10.6%) | 19 (12.3%) | 0.02 |
Coronary disease | 49 (19.9%) | 18 (11.7%) | 0.45 |
Peripheral Vascular disease | 11 (4.5%) | 12 (7.8%) | 0.12 |
Cerebrovascular disease | 18 (7.3%) | 17 (11%) | 0.05 |
Chronic respiratory disease | 9 (3.7%) | 8 (5.2%) | 0.04 |
Malignancies | 25 (10.2%) | 35 (22.7%) | 0.24 |
Transplantation | 14 (5.7%) | 11 (7.14%) | 1.02 |
Immunosuppresion | 38 (15.4%) | 24 (15.6%) | 0.87 |
Chronic renal disease | 22 (8.9%) | 19 (12.3%) | 0.04 |
Prosthetic device | 56 (22.8%) | 47 (30.5%) | 0.02 |
Charlson comorbidity index Score ≥ 3 | 102 (41%) | 67 (43.5%) | 0.02 |
Group A 2018–2019 (n = 246) | Group B 2020–2022 (n = 154) | p-Value | |
---|---|---|---|
Community-acquired infection | 96 (39%) | 56 (36.3%) | 0.001 |
Hospital-acquired infection | 150 (61%) | 98 (63.6%) | 0.001 |
Multidrug-resistant bacteria | 83 (33.7%) | 57 (37%) | 0.001 |
Focus of infection | |||
Unknown | 16 (6.5%) | 18 (11.7%) | 0.004 |
Central venous catheter | 46 (18.7%) | 31 (20.1%) | 0.156 |
Peripheral venous catheter | 34 (13.8%) | 21 (13.6%) | 0.458 |
Thrombophlebitis | 12 (4.9%) | 27 (17.5%) | 0.024 |
Implanted vascular device | 21 (8.5%) | 16 (10.4%) | 0.048 |
Infective endocarditis | 11 (4.5%) | 16 (10.4%) | 0.678 |
Native valve | 6 (2.4%) | 7 (4.5%) | 0.465 |
Prosthetic valve | 5 (2%) | 9 (5.8%) | 0.247 |
Joint infection | 10 (4.1%) | 9 (5.8%) | 0.765 |
Prosthetic joint infection | 15 (6.1%) | 19 (12.3%) | 0.223 |
Vertebral osteomyelitis | 13 (5.3%) | 17 (11%) | 0.058 |
Intra-abdominal infections | 26 (10%) | 18 (11.7%) | 0.047 |
Osteomyelitis/diabetic foot ulcers | 29 (11.8%) | 20 (13%) | 0.023 |
Skin and soft-tissue infections | 24 (9.8%) | 19 (12.3%) | 0.027 |
Respiratory infections | 32 (13%) | 21 (13.6%) | 0.057 |
Urinary tract infections | 19 (7.7%) | 16 (10.4%) | 0.077 |
Central nervous system infections | 9 (3.7%) | 7 (4.5%) | 0.065 |
Complicated infection | 134 (54.5%) | 87 (56.5%) | 0.001 |
Group A 2018–2019 (n = 246) | Group B 2020–2022 (n = 154) | p-Value | |
---|---|---|---|
Septic shock | 8 (3.3%) | 7 (4.5%) | 0.118 |
Hospitalization in ICU | 11 (4.5%) | 12 (7.8%) | 0.245 |
Hospital stay, days, mean ± SD | 29 (17–52) | 30 (16–51) | 0.457 |
Mortality | |||
Within 28 days | 12 (4.9%) | 16 (10.4%) | 0.001 |
Within 90 days | 19 (7.7%) | 23 (14.9%) | 0.001 |
Repeated blood culture | 137 (55.7%) | 56 (36.4%) | 0.001 |
Negative blood culture within 7 days | 98 (40%) | 48 (31.2%) | 0.001 |
Recurrent disease | 9 (3.6%) | 6 (3.9%) | 0.458 |
Duration of antibiotic treatment, days, mean ± SD | 15 (8–19) | 11 (6–12) | 0.04 |
Repeated clinical estimation | 112 (45.5%) | 36 (23.4%) | 0.001 |
Combination of antibiotics | 26 (10.6%) | 11 (7.1%) | 0.001 |
Recorded bloodstream infection (isolated pathogen) in discharge summary | 124 (50.4%) | 44 (28.6%) | 0.001 |
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Petrakis, V.; Panopoulou, M.; Rafailidis, P.; Lemonakis, N.; Lazaridis, G.; Terzi, I.; Papazoglou, D.; Panagopoulos, P. The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections. Pathogens 2023, 12, 780. https://doi.org/10.3390/pathogens12060780
Petrakis V, Panopoulou M, Rafailidis P, Lemonakis N, Lazaridis G, Terzi I, Papazoglou D, Panagopoulos P. The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections. Pathogens. 2023; 12(6):780. https://doi.org/10.3390/pathogens12060780
Chicago/Turabian StylePetrakis, Vasilios, Maria Panopoulou, Petros Rafailidis, Nikolaos Lemonakis, Georgios Lazaridis, Irene Terzi, Dimitrios Papazoglou, and Periklis Panagopoulos. 2023. "The Impact of the COVID-19 Pandemic on Antimicrobial Resistance and Management of Bloodstream Infections" Pathogens 12, no. 6: 780. https://doi.org/10.3390/pathogens12060780