Outcome and Risk Factors for Acquisition of Multi-Drug Resistant Organisms among COVID-19 Patients, A Single Center Case Control Study

Abstract

Introduction: Several recent reports have described an increase in multidrug-resistant organisms (MDROs) during the COVID- 19 pandemic, and multiple factors identified. Objectives: The primary objectives of the study are to determine the incidence of MDROs among hospitalized COVID-19 patients, the risk factors leading to infection or colonization with MDROs among these patients and the determinants of mortality among infected patients. The secondary objective is to study risk factors for mortality among the study cohort. Method: A retrospective case-control study included all patients screened for MDROs on admission or detected later to have a positive sample for MDROs during their hospital stay (April-September 2020). Associations were tested using chi-square and independent t-tests. For the adjusted analysis, Multivariate logistic regression applied. P<0.05 was considered as statistical significance. Result: The total number of patients included was 313. 33.2% (n=104) were MDRO-infected or colonized patients, and 66.8% (n=209) were controls. The incidence density during the study period of MDROs was 16.7 per 1000 patient days, and the incidence was 17. 9 per 100 admissions. The monthly incidence density of MDROs ranged from 7.0 per 1000 patient days to 30.6 per 1000 patient days and steadily increased. In univariate analysis, the length of ICU stays P <0.001, length of hospital stay P <0.001, receiving ventilation P0.001, having urinary catheter P0.004, tracheostomy P<0.001, NGT in situ P 0.001, receiving more than four antibiotics P<0.001 and having comorbidities P 0.001 were risk factors for acquiring MDROs. Comorbidities were independent factors for MDRO acquisition (OR 3.61, CI 1.37-9.61, P0.010). Mortality was higher among those with MDRO infection (50%, n=30) than those with colonization (31.8%, n=14). Only receiving a few antibiotics was related to worse outcomes (OR 3.09, CI; 1.13-8.44, P0.028). The independent risk factors for mortality among the study cohort were age (OR 1.087 CI 1.06 to 1.1, P <0.001), and acute dialysis (OR 4.392, CI 1.82-10.61, P 0.001). Conclusion: The acquisition of MDROs was not associated with worse outcomes among COVID-19 patients, although mortality was significantly higher among infected patients than colonized patients. Implementing strict infection prevention and control strategies is vital to prevent colonization and progression to infection among colonized patients.