Title : Antibiotic resistant pattern of the most frequently isolated bacteria of healthcare associated infections in patients in an intensive care unit before and during the COVID-19 pandemic
Abstract:
Introduction:
During the COVID-19 pandemic, an increase in healthcare associated infections was observed. A 41% incidence was reported among critically ill patients infected with COVID-19, and 50% of those requiring hospitalization in the intensive care unit were found to be infected with multidrug resistant bacteria. The most frequently isolated bacterial species were Staphylococcus aureus, Klebsiella pneumoniae and Streptococcus pneumoniae.
Objectives:
Compare and describe the antimicrobial resistance pattern of the most frequently isolated bacteria from healthcare associated infections in an intensive care unit before and during the COVID-19 pandemic in Lima, Peru.
Methods:
A cross-sectional descriptive study conducted in the adult intensive care unit of Hospital Cayetano Heredia. The study was carried out in two distinct time periods. The pre-COVID-19 group data was collected from January 1st, 2019, to March 6th 2020, while the COVID-19 group data was collected between March 7th 2020 and December 31st 2020. The data was compiled into a Microsoft Excel database and analyzed using Stata version 4.
Results:
Most of the isolated bacteria were Gram-negative. From the 42 bacteria isolates in the pre-COVID-19 group, Pseudomonas aeruginosa was the most frequent (14/42) followed by Klebsiella pneumoniae (9/42), while in the COVID-19 group from 129 isolates, Acinetobacter baumannii (46/129) was the most frequent followed by Pseudomonas aeruginosa (27/129). Pseudomonas aeruginosa showed similar resistance rates to carbapenems in both periods. The resistance rate to meropenem was 57,1% in the pre COVID-19 group and 55,6% in the COVID-19 group, while resistance to imipenem was 64,3% and 63%, respectively. Klebsiella pneumonia resistance to carbapenems increased from 11,1% in the pre COVID-19 group to 71,4% in the COVID-19 group. This bacterium also showed 66,7% resistance to amoxicillin-clavulanic acid and 33,3% resistance to cephalosporins, gentamicin, and ampicillin-sulbactam in the pre COVID-19 group. In contrast, the COVID-19 group showed that 95,2% of isolates were resistant to ceftriaxone, 90,5% to ciprofloxacin and 85,7% to cefepime. Stenotrophomonas maltophilia was an emergent bacteria in the COVID-19 group and showed resistance to ceftriaxone in 27,3% of isolates. 18,2% of isolates also showed resistance to carbapenems, aztreonam, ciprofloxacin, aminoglycosides, ampicillin-sulbactam, cefepime and amoxicillin-clavulanic acid. Resistance to trimetropin-sulfametoxazol, the first line treatment, was observed in 9.1% of isolates. Conclusion: Gram negative bacteria were the most frequently isolated during both periods. Acinetobacter baumannii and Pseudomonas aeruginosa showed similar carbapenem resistance in both periods, but Klebsiella pneumoniae showed an increase antimicrobial resistance to extended spectrum antibiotics, like carbapenems, aminoglycosides and third generation cephalosporins.
