Impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance among major pathogens causing healthcare-associated infection

Hao-Chun Chang; Che-Hao Chang; Kuei-Lien Tien; Chih-Hsun Tai; Li-Min Lin; Tai-Fen Lee; Shih-Chi Ku; Chi-Tai Fang; Yee-Chun Chen; Wang-Huei Sheng

doi:10.1016/j.jfma.2023.06.026

Impact of coronavirus disease 2019 (COVID-19) on antimicrobial resistance among major pathogens causing healthcare-associated infection

J Formos Med Assoc. 2024 Jan;123(1):123-132. doi: 10.1016/j.jfma.2023.06.026. Epub 2023 Jul 12.

Authors

Hao-Chun Chang¹, Che-Hao Chang², Kuei-Lien Tien³, Chih-Hsun Tai⁴, Li-Min Lin⁵, Tai-Fen Lee⁶, Shih-Chi Ku⁷, Chi-Tai Fang⁸, Yee-Chun Chen⁹, Wang-Huei Sheng¹⁰

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hsin-Chu Branch, Biomedical Park Hospital, Hsin-Chu County, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.
³ Infection Control Center, National Taiwan University Hospital, Taipei City, Taiwan.
⁴ Department of Pharmacy, National Taiwan University Hospital, Taipei City, Taiwan.
⁵ Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan.
⁶ Department of Laboratory Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
⁷ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
⁸ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
⁹ Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan.
¹⁰ Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei City, Taiwan. Electronic address: whsheng@ntu.edu.tw.

PMID: 37451958
DOI: 10.1016/j.jfma.2023.06.026

Abstract

Background: Coronavirus disease 2019 (COVID-19) has caused great impact on healthcare systems, including antibiotic usage and multi-drug resistant (MDR) bacterial infections at hospitals. We aim to investigate the trends of antimicrobial resistance among the major pathogens causing healthcare-associated infection (HAI) at intensive care units (ICU).

Material and methods: The demographic characteristics of hospitalization, usage of antimicrobial agents, counted by half-an-year DID (defined daily dose per 1000 patient-days), and HAI density of five major MDR bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Klebsiella pneumoniae (CRKP), and carbapenem-resistant Pseudomonas aeruginosa (CRPA), of ICU patients at a medical center in Taiwan during January 2017 to December 2021 were collected and analyzed.

Results: The total antibiotic usage, counted by DID, had a significant increasing trend, before COVID-19 occurrence in 2017-2019, but no further increase during the pandemic period in 2020-2021. However, comparing the two time periods, antibiotics consumption was significantly increased during pandemic period. There was no significant change of HAI density in MRSA, VRE, CRAB, CRKP, and CRPA, comparing the pandemic to the pre-pandemic period. Although, CRKP and CRPA infection rates were increasing during the pre-pandemic period, there was no further increase of CRKP and CRPA HAI rates during the pandemic period.

Conclusion: During COVID-19 pandemic, there was no significant increase in HAI density of five major MDR bacteria at ICU in Taiwan, despite increased antibiotic usage. Strict infection prevention measures for COVID-19 precautions and sustained antimicrobial stewardship probably bring these effects.

Keywords: Antibiotic usage; COVID-19 pandemic; Healthcare-associated infection; Multi-drug resistant bacteria.

MeSH terms

Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Anti-Infective Agents*
COVID-19* / epidemiology
Carbapenems / therapeutic use
Cross Infection* / drug therapy
Cross Infection* / epidemiology
Delivery of Health Care
Drug Resistance, Bacterial
Humans
Methicillin-Resistant Staphylococcus aureus*
Pandemics

Substances

Anti-Bacterial Agents
Anti-Infective Agents
Carbapenems