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Microorganisms
Volume 14
Issue 9
10.3390/microorganisms14092098
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Article

Multidrug-Resistant Bloodstream Infections Before and After COVID-19: A Temporal Assessment of Outcomes and Resistance Across Two Eras in a Non-COVID Intensive Care Unit—The MATURATE ICU Study

by
Sotiria Kefala
1,
Foteini Fligou
1,2,
Ioannis Chandroulis
3,
Marina Amerali
1,
Stamatia Tsoupra
1,
Eirini Zarkadi
1,
Eleni Polyzou
4,*,
Panagiota Pnevmatikou
5,
Fevronia Kolonitsiou
2,5 and
Karolina Akinosoglou
2,3,4,6
1
Department of Anesthesiology and Intensive Care, University General Hospital of Patras, 26504 Rio, Greece
2
Faculty of Medicine, University of Patras, 26504 Rio, Greece
3
School of Science and Technology, Hellenic Open University, 26335 Patras, Greece
4
Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece
5
Department of Microbiology, University General Hospital of Patras, 26504 Rio, Greece
6
Division of Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
*
Author to whom correspondence should be addressed.
Microorganisms 2026, 14(9), 2098; https://doi.org/10.3390/microorganisms14092098 (registering DOI)
Submission received: 18 August 2026 / Revised: 10 September 2026 / Accepted: 15 September 2026 / Published: 19 September 2026
(This article belongs to the Special Issue Infections in the Critically Ill: Multi-Drug Resistance and Emerging Frontiers in ICU Infectious Diseases)
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Abstract

The COVID-19 pandemic redirected infection control and antimicrobial stewardship towards SARS-CoV-2, potentially increasing multidrug-resistant (MDR) bloodstream infections (BSIs). We compared MDR BSI epidemiology and outcomes in a non-COVID intensive care unit (ICU) before and after the pandemic. The MATURATE ICU study retrospectively included adults with MDR BSIs admitted to a non-COVID ICU during the pre-COVID-19 (1 January 2017–1 January 2020) and post-COVID-19 (1 January 2022–1 January 2025) eras. Clinical, microbiological and outcome data were compared. Survival analyses and multivariable logistic regression identified predictors of ICU mortality. Overall, 146 patients were included (74 pre-COVID-19 and 72 post-COVID-19). Pre-COVID-19 patients were older and had higher comorbidity burden and severity indices (all p ≤ 0.023). ICU stay after the first positive blood culture was longer in the post-COVID-19 period (p = 0.003). New organ dysfunction, acute kidney injury, and septic shock were more frequent pre-COVID-19, whereas cardiovascular events were more frequent post-COVID-19. ICU mortality was higher pre-COVID-19 (p < 0.001). Competing-risk analysis, treating ICU discharge alive as a competing event, demonstrated a significantly lower cumulative incidence of ICU death in the post-COVID-19 era (adjusted sHR 0.20, 95% CI 0.11–0.35; p < 0.001). In multivariable analysis, post-COVID-19 era independently predicted lower 28-day ICU mortality (adjusted OR = 0.11, 95% CI 0.04–0.28, p < 0.001), whereas higher CCI (adjusted OR = 1.31, 95% CI 1.04–1.69, p = 0.027) and SOFA (adjusted OR = 1.22, 95% CI 1.07–1.40, p = 0.003) independently predicted increased mortality. Despite the persistently high burden of antimicrobial resistance, improved post-COVID-19 survival suggests that, advances in ICU care and healthcare system recovery may have contributed to better outcomes.
Keywords: antimicrobial resistance; ICU; COVID-19; multidrug-resistant pathogens; bloodstream infections antimicrobial resistance; ICU; COVID-19; multidrug-resistant pathogens; bloodstream infections

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MDPI and ACS Style

Kefala, S.; Fligou, F.; Chandroulis, I.; Amerali, M.; Tsoupra, S.; Zarkadi, E.; Polyzou, E.; Pnevmatikou, P.; Kolonitsiou, F.; Akinosoglou, K. Multidrug-Resistant Bloodstream Infections Before and After COVID-19: A Temporal Assessment of Outcomes and Resistance Across Two Eras in a Non-COVID Intensive Care Unit—The MATURATE ICU Study. Microorganisms 2026, 14, 2098. https://doi.org/10.3390/microorganisms14092098

AMA Style

Kefala S, Fligou F, Chandroulis I, Amerali M, Tsoupra S, Zarkadi E, Polyzou E, Pnevmatikou P, Kolonitsiou F, Akinosoglou K. Multidrug-Resistant Bloodstream Infections Before and After COVID-19: A Temporal Assessment of Outcomes and Resistance Across Two Eras in a Non-COVID Intensive Care Unit—The MATURATE ICU Study. Microorganisms. 2026; 14(9):2098. https://doi.org/10.3390/microorganisms14092098

Chicago/Turabian Style

Kefala, Sotiria, Foteini Fligou, Ioannis Chandroulis, Marina Amerali, Stamatia Tsoupra, Eirini Zarkadi, Eleni Polyzou, Panagiota Pnevmatikou, Fevronia Kolonitsiou, and Karolina Akinosoglou. 2026. "Multidrug-Resistant Bloodstream Infections Before and After COVID-19: A Temporal Assessment of Outcomes and Resistance Across Two Eras in a Non-COVID Intensive Care Unit—The MATURATE ICU Study" Microorganisms 14, no. 9: 2098. https://doi.org/10.3390/microorganisms14092098

APA Style

Kefala, S., Fligou, F., Chandroulis, I., Amerali, M., Tsoupra, S., Zarkadi, E., Polyzou, E., Pnevmatikou, P., Kolonitsiou, F., & Akinosoglou, K. (2026). Multidrug-Resistant Bloodstream Infections Before and After COVID-19: A Temporal Assessment of Outcomes and Resistance Across Two Eras in a Non-COVID Intensive Care Unit—The MATURATE ICU Study. Microorganisms, 14(9), 2098. https://doi.org/10.3390/microorganisms14092098

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