Bianca B.P. Antunes PhD , Leonardo S.L. Bastos PhD , Pedro Kurtz PhD , Letícia M. Sant’Anna BSc , Pedro F. del Peloso PhD , Claudia A. Espanha MS , Silvio Hamacher PhD , Fernando A. Bozza MD, PhD
{"title":"机械通气 ICU 患者对碳青霉烯耐药性的持续存在：COVID-19 浪潮前后的分析。","authors":"Bianca B.P. Antunes PhD , Leonardo S.L. Bastos PhD , Pedro Kurtz PhD , Letícia M. Sant’Anna BSc , Pedro F. del Peloso PhD , Claudia A. Espanha MS , Silvio Hamacher PhD , Fernando A. Bozza MD, PhD","doi":"10.1016/j.ajic.2024.10.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The evolution of antimicrobial resistance among critically ill patients before, during, and after the COVID-19 surge remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed critically ill mechanically ventilated adult patients admitted to 8 Brazilian hospitals from Jan 1, 2018 to Apr 30, 2023. We stratified the patients into 3 periods: pre-surge (Jan 01, 2018-Mar 01, 2020), surge (Mar 01, 2020-Oct 01, 2021), and post-surge (after October 01, 2021). Positive cultures, pathogen prevalence, and resistance rates were analyzed using rate ratios (RR) with 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 9,780 patients (3,718 pre-surge, 3,815 surge, 2,247 post-surge), those in surge period were younger (median: 70 vs 74 pre-surge vs 75 post surge) and had longer invasive mechanical ventilation duration (median 7 vs 5 days). Blood and respiratory cultures increased across periods (56.9 pre-surge vs 69.4 surge vs 70.4 patients/1,000 patient-days post-surge). Isolation of carbapenem-resistant gram-negatives increased during the surge (RR [95% CI]: 1.8 [1.5-2.2], decreased in post-surge (0.72 [0.6-0.9]), and remained higher than pre-surge (1.3 [1.0-1.6]). Resistance rates for <em>Pseudomonas aeruginosa</em> reduced in post-surge, whereas <em>Klebsiella pneumoniae</em> doubled during the surge, and remained elevated.</div></div><div><h3>Conclusions</h3><div>Carbapenem resistance increased during the surge period. Although it decreased post-surge, it remained higher than pre-pandemic rates.</div></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":"53 3","pages":"Pages 320-325"},"PeriodicalIF":2.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Persistent carbapenem resistance in mechanically ventilated ICU patients: A before-and-after analysis of the COVID-19 surge\",\"authors\":\"Bianca B.P. Antunes PhD , Leonardo S.L. Bastos PhD , Pedro Kurtz PhD , Letícia M. Sant’Anna BSc , Pedro F. del Peloso PhD , Claudia A. Espanha MS , Silvio Hamacher PhD , Fernando A. Bozza MD, PhD\",\"doi\":\"10.1016/j.ajic.2024.10.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The evolution of antimicrobial resistance among critically ill patients before, during, and after the COVID-19 surge remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed critically ill mechanically ventilated adult patients admitted to 8 Brazilian hospitals from Jan 1, 2018 to Apr 30, 2023. We stratified the patients into 3 periods: pre-surge (Jan 01, 2018-Mar 01, 2020), surge (Mar 01, 2020-Oct 01, 2021), and post-surge (after October 01, 2021). Positive cultures, pathogen prevalence, and resistance rates were analyzed using rate ratios (RR) with 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Among 9,780 patients (3,718 pre-surge, 3,815 surge, 2,247 post-surge), those in surge period were younger (median: 70 vs 74 pre-surge vs 75 post surge) and had longer invasive mechanical ventilation duration (median 7 vs 5 days). Blood and respiratory cultures increased across periods (56.9 pre-surge vs 69.4 surge vs 70.4 patients/1,000 patient-days post-surge). Isolation of carbapenem-resistant gram-negatives increased during the surge (RR [95% CI]: 1.8 [1.5-2.2], decreased in post-surge (0.72 [0.6-0.9]), and remained higher than pre-surge (1.3 [1.0-1.6]). Resistance rates for <em>Pseudomonas aeruginosa</em> reduced in post-surge, whereas <em>Klebsiella pneumoniae</em> doubled during the surge, and remained elevated.</div></div><div><h3>Conclusions</h3><div>Carbapenem resistance increased during the surge period. Although it decreased post-surge, it remained higher than pre-pandemic rates.</div></div>\",\"PeriodicalId\":7621,\"journal\":{\"name\":\"American journal of infection control\",\"volume\":\"53 3\",\"pages\":\"Pages 320-325\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of infection control\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0196655324008010\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/19 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of infection control","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0196655324008010","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/19 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Persistent carbapenem resistance in mechanically ventilated ICU patients: A before-and-after analysis of the COVID-19 surge
Background
The evolution of antimicrobial resistance among critically ill patients before, during, and after the COVID-19 surge remains unclear.
Methods
We retrospectively analyzed critically ill mechanically ventilated adult patients admitted to 8 Brazilian hospitals from Jan 1, 2018 to Apr 30, 2023. We stratified the patients into 3 periods: pre-surge (Jan 01, 2018-Mar 01, 2020), surge (Mar 01, 2020-Oct 01, 2021), and post-surge (after October 01, 2021). Positive cultures, pathogen prevalence, and resistance rates were analyzed using rate ratios (RR) with 95% confidence intervals (CI).
Results
Among 9,780 patients (3,718 pre-surge, 3,815 surge, 2,247 post-surge), those in surge period were younger (median: 70 vs 74 pre-surge vs 75 post surge) and had longer invasive mechanical ventilation duration (median 7 vs 5 days). Blood and respiratory cultures increased across periods (56.9 pre-surge vs 69.4 surge vs 70.4 patients/1,000 patient-days post-surge). Isolation of carbapenem-resistant gram-negatives increased during the surge (RR [95% CI]: 1.8 [1.5-2.2], decreased in post-surge (0.72 [0.6-0.9]), and remained higher than pre-surge (1.3 [1.0-1.6]). Resistance rates for Pseudomonas aeruginosa reduced in post-surge, whereas Klebsiella pneumoniae doubled during the surge, and remained elevated.
Conclusions
Carbapenem resistance increased during the surge period. Although it decreased post-surge, it remained higher than pre-pandemic rates.
期刊介绍：
AJIC covers key topics and issues in infection control and epidemiology. Infection control professionals, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC)
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