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Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  18 March 2022

Ana Paula M. Porto ,
Igor C. Borges Open the ORCID record for Igor C. Borges [Opens in a new window] ,
Lewis Buss Open the ORCID record for Lewis Buss [Opens in a new window] ,
Anna Machado ,
Bil R. Bassetti Open the ORCID record for Bil R. Bassetti [Opens in a new window] ,
Brunno Cocentino ,
Camila S. Bicalho ,
Claudia M.D.M. Carrilho ,
Cristhieni Rodrigues  and
Eudes A.S. Neto Open the ORCID record for Eudes A.S. Neto [Opens in a new window]
...Show all authors
Ana Paula M. Porto
Affiliation:
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Igor C. Borges
Affiliation:
Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Lewis Buss
Affiliation:
Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Anna Machado
Affiliation:
Hospital Maternidade de Campinas, Campinas, Brazil
Bil R. Bassetti
Affiliation:
Hospital Estadual Central, Vitória, Espírito Santo, Brazil
Brunno Cocentino
Affiliation:
Hospital Paulistano, São Paulo, Brazil
Camila S. Bicalho
Affiliation:
Hospital Regional de Sorocaba Dr Adib Jatene, Sorocaba, Brazil
Claudia M.D.M. Carrilho
Affiliation:
Hospital Universitário de Londrina, Londrina, Brazil
Cristhieni Rodrigues
Affiliation:
Hospital Santa Paula, São Paulo, Brazil
Eudes A.S. Neto
Affiliation:
Hospital São Domingos, São Luís, Brazil
Evelyne S. Girão
Affiliation:
Hospital Regional da Unimed, Fortaleza, Brazil Hospital São José, Fortaleza, Brazil Hospital Universitário Walter Cantídio, Fortaleza, Brazil
Filipe Piastrelli
Affiliation:
Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
Giovanna Sapienza
Affiliation:
Hospital Estadual de Sapopemba, São Paulo, Brazil
Glaucia Varkulja
Affiliation:
Hospital Santa Catarina, São Paulo, Brazil
Karin Kolbe
Affiliation:
Hospital São Luiz Unidade São Caetano, São Caetano do Sul, Brazil
Luciana Passos
Affiliation:
Hospital Unimed Vitória, Vitória, Brazil
Patricia Esteves
Affiliation:
Hospital Estadual de Diadema Governador Orestes Quércia, Diadema, Brazil
Pollyana Gitirana
Affiliation:
Vitória Apart Hospital, Serra, Brazil
Regia D.F. Feijó
Affiliation:
Hospital Estadual de Vila Alpina, São Paulo, Brazil
Rosane L. Coutinho
Affiliation:
Hospital Alvorada, São Paulo, Brazil
Thais Guimarães
Affiliation:
Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
Tiago L.L. Ferraz
Affiliation:
Real Hospital Português de Beneficência, Recife, Brazil
Anna S. Levin
Affiliation:
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
Silvia F. Costa*
Affiliation:
Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
*
Author for correspondence: Silvia Figueiredo Costa, E-mail: silviacosta@usp.br
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Abstract

Objective:

The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs).

Methods:

In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line–associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD).

Results:

We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44–4.20) vs 2.81 (IQR, 1.35–6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin–tazobactam, meropenem, or vancomycin consumption between the studied periods.

Conclusions:

There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 2 , February 2023 , pp. 284 - 290
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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