The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital

Gökhan Metan; Mervenur Demir Çuha; Gülsen Hazirolan; Gülçin Telli Dizman; Elif Seren Tanriverdi; Baris Otlu; Zahit Tas; Pinar Zarakolu; Zafer Arik; Arzu Topeli; Seda Banu Akinci; Serhat Ünal; Ömrüm Uzun

doi:10.3205/dgkh000418

The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital

GMS Hyg Infect Control. 2022 Aug 29:17:Doc15. doi: 10.3205/dgkh000418. eCollection 2022.

Authors

Gökhan Metan^{1

2}, Mervenur Demir Çuha³, Gülsen Hazirolan³, Gülçin Telli Dizman^{1

2}, Elif Seren Tanriverdi⁴, Baris Otlu⁴, Zahit Tas¹, Pinar Zarakolu¹, Zafer Arik⁵, Arzu Topeli⁶, Seda Banu Akinci⁷, Serhat Ünal^{1

2}, Ömrüm Uzun¹

Affiliations

¹ Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
² Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey.
³ Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
⁴ Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey.
⁵ Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
⁶ Section of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.
⁷ Section of Intensive Care Medicine Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Abstract
in English, German

We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.

Es wurden die Veränderungen in der Epidemiologie nosokomialer Blutstrominfektionen (BSI) durch multiresistente Bakterien und die Antibiotika-Verbrauchsraten während der COVID-19 Pandemie in einem mit an COVID-19 Erkrankten belegten Krankenhaus und der Onkologischen Klinik auf demselben Universitätsgelände ohne Belegung mit COVID-19 Patienten untersucht. Im Pandemiekrankenhaus wurde ein signifikanter Anstieg der Infektionsdichte (IDR) von BSI, verursacht durch Carbapenem-resistente Acinetobacter baumannii (CRAB) und Ampicillin-resistente Enterococcus faecium (ARE), festgestellt, während Carbapenem-resistente Klebsiella pneumoniae BSI in der nicht-pandemischen Onkologischen Klinik erhöht waren. Die Pulsfeld-Gel-Elektrophorese zeigte einen polyklonalen Ausbruch von CRAB auf den COVID-19-Intensivstationen. Der Antibiotikaverbrauch war bei fast allen Antibiotika erhöht, am stärksten bei Meropenem in beiden Krankenhäusern. Erhöhte IDRs von CRAB und ARE BSIs sowie ein erhöhter Verbrauch von Breitspektrum-Antibiotika unterstreichen die Bedeutung einer multimodalen Strategie zur Infektionsprävention in Kombination mit einem aktiven Antibiotic-Stewardship-Programm.

Keywords: COVID-19; SARS-CoV-2; antibacterial resistance; antibiotic consumption; bacteremia.

Abstract in English, German

Abstract
in English, German