Prevalence and temporal trends of critical infections due to multidrug-resistant bacteria (ESKAPE) in nine tertiary hospitals of Rio de Janeiro in the COVID-19 era

Abstract

Introduction: Antimicrobial resistance is a serious threat to public health worldwide. This fact becomes more relevant in the COVID-19 era considering the inappropriate use of antimicrobials. An important representative of multidrug-resistant (MDR) bacteria is the ESKAPE group. The prevalence of these pathogens in Rio de Janeiro in COVID-19 patients is still unknown. The aim of the current study was to determine the prevalence and temporal trends of critical infections due to ESKAPE microorganisms in nine tertiary hospitals of Rio de Janeiro in the COVID-19 pandemic. Methods: Prospective study performed in nine tertiary private hospitals of Rio de Janeiro between March 2020 and October 2021. Electronic medical records were retrieved from the computerized database of the hospitals clinical microbiology laboratories. Bacterial identification/antibiotic susceptibility testing were performed by automated methodologies and statistical analyses were performed for comparative purposes. Results: In total, 1812 cultures from 1653 patients were evaluated. The data revealed that among the ESKAPE microorganisms, the highest prevalence was for Klebsiella pneumoniae and Acinetobacter baumannii. In the analysis of the temporal trends of the distribution of the MDR bacteria, we observed that the COVID-19 patients had a stable distribution during the study period, while the prevalence for these pathogens increased in the non-COVID-19 patients Conclusion: We confirmed an increase in the prevalence of MDR bacteria (including ESKAPE group) in COVID-19 patients, specifically of non-fermenting Gram-negative bacteria. We also observed that the indiscriminate use of antibiotics in COVID-19 patients had a cumulative impact on infections of non-COVID-19 patients.