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Long term impact of the SARS-CoV2 pandemic on the acquisition rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a medical intensive care unit

Year: 2025

Type: article

Abstract: BACKGROUND: The COVID-19 pandemic led to major changes in patient care, with enhanced hygiene possibly reducing multidrug resistant bacteria transmission, while increased nursing workload and antibiotic use may have raised the risk of multidrug resistant bacteria acquisition. METHODS: A 5-year retrospective study compared extended spectrum beta lactamase Enterobacteriaceae (ESBL-E) acquisition rates in a single intensive care unit (ICU) between the pre-COVID and COVID periods. RESULTS: Between January 2018 and December 2022, 1,736 ICU patients (mean age 64 [49-79] years) were included. Admission severity was similar across periods, but ICU stay was longer during COVID (19 ± 19 vs 14 ± 13 days, P < .001), with more patients requiring mechanical ventilation (81% vs 73%, P < .001) for a longer duration (17 ± 19 vs 10 ± 10 days, P < .001). ESBL-E acquisition increased by 57.3% during the COVID period (14% [confidence interval (CI) 95 11.6-16.7] vs 8.9% [CI 95 7.1-11.0], P = .001), while admission carriage rates were similar (6% vs 8%, P = .57). In multivariate analysis, ICU stay duration (odds ratio [OR] = 1.01 per day), mechanical ventilation > 10 days, ESBL-E prevalence, and hemodialysis were associated with acquisition; noninvasive ventilation was protective. CONCLUSIONS: In our ICU, ESBL-E acquisition increased during the COVID period. Multivariate analysis linked it to length of stay, ESBL-E prevalence, mechanical ventilation > 10 days, and hemodialysis. Further studies are needed to assess post-COVID trends.

Source: American Journal of Infection Control

DOI: 10.1016/j.ajic.2025.09.013