Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2022.0020
Iberoamerican Journal of Medicine
Original article

Rising incidence of carbapenem resistant isolates: an Argentinian hospital’s experience. More trouble in the aftermath of the COVID-19 pandemic

Incidencia creciente de aislamientos resistentes a carbapenémicos: la experiencia de un hospital argentino. Más problemas tras la pandemia de COVID-19

Maximiliano Gabriel Castro, Lucía Ubiergo, Macarena Vicino, Gisel Cuevas, Fernanda Argarañá

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Abstract

Introduction: During COVID-19 outbreaks, disproportionate use of antibiotics, high Intensive Care Units burden and longer in-hospital stays may have aggravated the emergency posed by carbapenem-resistant isolates. Therefore, we set out to determine whether the incidence of carbapenem-resistant isolates rose in a tertiary care center in Santa Fe, Argentina during the period with active cases of COVID-19.
Material and methods: In this retrospectively designed analytic epidemiologic study, two periods were defined: Period 1 (without active cases of COVID-19) from September 2019 to August 2020 and Period 2 (starting at the onset of the first wave of COVID-19 in this Institution) from September 2020 to June 2021. All clinically relevant microbiological samples taken during these periods in the Internal Medicine, Surgical and Intensive Care Unit wards were included. The primary analysis of interest was the differential incidence between the two periods, overall and in the Intensive Care Units wards in particular.
Results: 9,135 hospitalizations, 50,145 patient-days of analysis. 7,285 clinical samples were taken, with an overall positivity for carbapenem-resistant isolates of 12.1% (n=883). Overall carbapenem-resistant isolates incidence during Period 2 was 2.5 times higher than in Period 1 (2.52 vs 0.955/100 patient-days, p<0.001). Intensive Care Units’ carbapenem-resistant isolates incidence raised from 6.78 to 8.69/100 patient-days in Period 2 (p=0.006).
Conclusions: We found alarming rates of carbapenem-resistant isolates in our center, 2.5 times higher in the period following the first wave of COVID-19. This rise was due to a higher amount of clinically relevant microbiological samples taken and to a higher carbapenem resistance among Enterobacteria and non-fermentative Gram-negative bacilli. To our knowledge, this is one of the few Latin-American reports on the effect of the COVID-19 pandemic on carbapenem-resistant isolates incidence.

Keywords

Carbapenem-resistant Enterobacteriaceae; Antibiotic resistance; COVID-19; SARS-CoV-2; Outbreak

Resumen

Introducción: Durante los brotes de COVID-19, el uso desproporcionado de antibióticos, la alta carga de las Unidades de Cuidados Intensivos y las estancias hospitalarias más prolongadas pueden haber agravado la emergencia planteada por los aislados resistentes a carbapenémicos. Por lo tanto, nos propusimos determinar si la incidencia de aislamientos resistentes a carbapenémicos aumentó en un centro de tercer nivel de atención en Santa Fe, Argentina, durante el período con casos activos de COVID-19.
Material y métodos: En este estudio epidemiológico analítico de diseño retrospectivo se definieron dos periodos: Periodo 1 (sin casos activos de COVID-19) de septiembre de 2019 a agosto de 2020, y Periodo 2 (a partir del inicio de la primera ola de COVID-19. en esta Institución) desde septiembre de 2020 hasta junio de 2021. Se incluyeron todas las muestras microbiológicas clínicamente relevantes tomadas durante estos períodos en las salas de Medicina Interna, Quirúrgica y Unidad de Cuidados Intensivos. El principal análisis de interés fue la incidencia diferencial entre los dos períodos, en general y en las salas de las Unidades de Cuidados Intensivos en particular.
Resultados: 9.135 hospitalizaciones, 50.145 pacientes-día de análisis. Se tomaron 7.285 muestras clínicas, con una positividad global para aislados resistentes a carbapenémicos del 12,1% (n=883). La incidencia general de aislamientos resistentes a carbapenémicos durante el Período 2 fue 2,5 veces mayor que en el Período 1 (2,52 frente a 0,955/100 pacientes-día, p<0,001). La incidencia de aislamientos resistentes a carbapenémicos en Unidades de Cuidados Intensivos aumentó de 6,78 a 8,69/100 pacientes-día en el Período 2 (p=0,006).
Conclusiones: Encontramos tasas alarmantes de aislamientos resistentes a carbapenémicos en nuestro centro, 2,5 veces mayores en el período posterior a la primera ola de COVID-19. Este aumento se debió a una mayor cantidad de muestras microbiológicas clínicamente relevantes tomadas ya una mayor resistencia a carbapenémicos entre Enterobacterias y bacilos Gram-negativos no fermentadores. Hasta donde sabemos, este es uno de los pocos informes latinoamericanos sobre el efecto de la pandemia de COVID-19 en la incidencia de aislados resistentes a carbapenem.

Palabras clave

Enterobacterias resistentes a carbapenémicos; Resistencia a los antibióticos; COVID-19; SARS-CoV-2; Brote

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Submitted date:
02/23/2022

Reviewed date:
03/27/2022

Accepted date:
04/12/2022

Publication date:
04/12/2022

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