Evaluation of health care-associated infections in the intensive care unit during the one-year period of the COVID-19 pandemic and the one-year period before

Objective: In our study, the development of healthcare-associated infections (HAIs), the type distribution of HAIs, the agent distribution, the antibiotic susceptibilities of the microorganisms grown, the epidemiologic data of the patients, and mortality rates of the patients followed up in our hospital during the pandemic period and one year before the pandemic were examined. By questioning the host factors and environmental factors that may cause these findings, it was aimed to evaluate the effect of the pandemic process on HAIs. Materials and Methods: Between March 15, 2019 and March 14, 2020, one-year period before the COVID-19 pandemic and between March 15, 2020 and March 14, 2021, one-year period during the COVID-19 pandemic, patients hospitalized in Ankara City Hospital General Hospital Building 1C Anesthesia and Reanimation Intensive Care Unit (ICU) were retrospectively analyzed. Patients aged 18 years and older who were diagnosed with SHIE during ICU follow-up in the one-year period before the pandemic and patients diagnosed with SHIE and COVID-19 during ICU follow-up in the one-year period during the pandemic were included in the study. In patients who developed SHIE, characteristics such as ICU length of stay, time of agent growth, types of SHIE, causative microorganisms, antibiotherapies used, and resistance profiles of agents were analyzed. In addition, data on sex, ICU length of stay, antibiotic consumption index, invasive device utilization rate and mortality rate in all patients aged 18 years and older who were followed up in the ICU in the one-year periods before COVID-19 were included in the study. Statistical Package for the Social Sciences (SPSS) Statistics for Windows version 20.0 was used for statistical analysis of the data, and p<0.05 was considered significant. Results: In our study, 58 (15.2%) of 380 patients hospitalized in the ICU in the one-year period before COVID-19 and 102 (22.4%) of 455 patients hospitalized in the ICU in the first year of the COVID-19 pandemic were diagnosed with SHIE. In patients who developed SHIE in the pre-COVID-19 period, ICU length of stay, time to the first SHIE episode, APACHE-II and SOFA scores were significantly higher compared to the COVID-19 period (p<0.05). When the rates of use of invasive devices in all patients hospitalized in the ICU in one-year periods were analyzed, the rates of mechanical ventilation and central venous catheter use were significantly higher in our group before the pandemic (p<0.05). When SHIEs were compared, SHIE density, laboratory-confirmed bloodstream infection (LTD-CDE) density, VIP and LTBI rates were significantly higher in the COVID-19 period (p<0.05). Regarding SIRs, VIP SIRs were significantly higher in the 2nd and 4th quarters of the COVID-19 period compared to the 2nd and 4th quarters before COVID-19. In the 1st and 2nd quarters of the COVID-19 period, CI-ICU SIRs were significantly higher compared to the 1st and 2nd quarters before COVID-19 (p<0.05). Acinetobacter spp. growth was the most common in both periods. When VIP agents were compared, the growth rate of S. maltophilia was significantly higher in the COVID-19 period (p=0.03). In the pre-COVID-19 period, quinolone, carbapenem and aminoglycoside resistance rates were significantly higher in Klebsiella spp. growths (p<0.05). When other microorganisms were analyzed, resistance rates were similar in both periods (p>0.05). In patients who developed SHIE, the rates of carbapenem and colistin use before COVID-19 were significantly higher compared to the COVID-19 period (p<0.05). When the annual antibiotic consumption indices of all patients were compared, the rates of meropenem and piperacillin-tazobactam use were higher in the COVID-19 period (p<0.05). Mortality rates were similar in the two periods (p=0.45). Conclusion: In our study, it is thought that the fact that our patient group, who developed SHIE in the pre-COVID-19 period, consisted of patients requiring palliative care and with high chronic disease scores may be effective in the higher ICU length of stay and invasive device utilization rates. During the pandemic period, the increasing number of patients, the lack of adequate and competent personnel, the increase in emergency interventions, and the fact that healthcare workers performed procedures requiring contact with the patient at one time due to the fear of being infected with COVID-19 may have contributed to the increase in the rate and density of HAIs by causing disruptions in compliance with infection control measures. In order to prevent resistance development and HAIs, compliance with infection control measures and antibiotic stewardship are among the most important issues to be considered. In addition, the opening of appropriate centers for patients requiring palliative care and early transfer of patients with no indication for intensive care to these centers will also contribute significantly to the prevention of HAIs.