A Multicenter Comparison of Prevalence and Predictors of Antimicrobial Resistance in Hospitalized Patients Before and During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. (17th October 2022)

• Record Type: Journal Article
• Authors: Bauer, Karri A; Puzniak, Laura A; Yu, Kalvin C; Klinker, Kenneth P; Watts, Janet A; Moise, Pamela A; Finelli, Lyn; Ai, ChinEn; Gupta, Vikas
• Is Part Of: Open forum infectious diseases. Volume 9:Number 11(2022)
• Publication Date: 2022-10-17
• Subjects: antibiotics -- antimicrobial stewardship -- antimicrobial resistance -- COVID-19 -- nosocomial infections; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac537
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Antibacterial therapy is frequently used in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without evidence of bacterial infection, prompting concerns about increased antimicrobial resistance (AMR). We evaluated trends in AMR before and during the SARS-CoV-2 pandemic. Methods: This multicenter, retrospective cohort analysis included hospitalized adults aged ≥18 years with >1-day inpatient admission and a record of discharge or death from 271 US facilities in the BD Insights Research Database. We evaluated rates of AMR events, defined as positive cultures for select gram-negative and gram-positive pathogens from any source, with nonsusceptibility reported by commercial panels before (1 July 2019–29 February 2020) and during (1 March 2020–30 October 2021) the SARS-CoV-2 pandemic. Results: Of 5 518 666 admissions evaluated, AMR rates per 1000 admissions were 35.4 for the prepandemic period and 34.7 for the pandemic period ( P ≤ .0001). In the pandemic period, AMR rates per 1000 admissions were 49.2 for SARS-CoV-2–positive admissions, 41.1 for SARS-CoV-2–negative admissions, and 25.7 for patients untested ( P ≤ .0001). AMR rates per 1000 admissions among community-onset infections during the pandemic were lower versus prepandemic levels (26.1 vs 27.6; P < .0001), whereas AMR rates for hospital-onset infections were higher (8.6 vs 7.7; P < .0001), driven largely by SARS-CoV-2–positive admissions (21.8). AMR rates were associated with overall antimicrobial use, rates of positive cultures, and higher use of inadequate empiric therapy. Conclusions: Although overall AMR rates did not substantially increase from prepandemic levels, patients tested for SARS-CoV-2 infection had a significantly higher rate of AMR and hospital-onset infections. Antimicrobial and diagnostic stewardship is key to identifying this high-risk AMR population. Abstract : Although overall antimicrobial resistance (AMR) rates were largely comparable before and during the SARS-CoV-2 pandemic, rates were higher among SARS-CoV-2–positive admissions with hospital-onset setting. Greater use of antimicrobial therapy and inadequate empiric therapy were associated with higher AMR.