The impact of COVID-19 pandemic on healthcare-associated infections in intensive care units: results from Egypt National Healthcare-associated Infections surveillance 2019-2020.
ABSTRACT
Background:
COVID-19 pandemic resulted in unexpected influx of patients leading to high rates of hospitalization. Focusing resources to mitigate pandemic unintentionally reduced attention to healthcare-associated infections (HAIs) prevention programs. Intensive care units (ICUs) have suffered most burden due to requirement of ventilation.
Objective:
We estimated national HAIs rates at ICUs before and during COVID-19 pandemic to better identify pandemic impact on HAIs.
Methods:
Egypt HAI surveillance established 2016 in 177 governmental ICUs. CDC case definitions and questionnaire is used to collect patients’ data. Types of HAIs targeted includes Bloodstream infections (BSI), pneumonia, and urinary tract infections (UTIs). Pathogens identification and antimicrobial resistance is performed at the Central laboratory. Surveillance data 2019-2020 was obtained, descriptive data analysis performed. HAIs Rates per 100 pt. days, and device-associated infections (DAIs) per 1000 device days were compared between 2019 and 2020.
Results:
In 2020 4,028 HAIs reported including 777(19.3%) ICU-acquired while in 2019, 6,242 reported including 1,084(17.4%) ICU-acquired. Incidence significantly decreased in 2020 than 2019 (2.67 vs 2.72, p<0.001). Percents of BSI, pneumonia, UTI in 2020 vs 2019 were (64.0% vs 61.6% and 10.9% vs 12.1% and 25.1% vs 23.8%). DAIs decreased significantly including CLABSI (2.6 vs 2.5, p<0.001) VAP (0.75 vs 0.87, p=0.04) CAUTI (1.5 vs 1.6, p=0.02). Klebsiella spp. was the predominant pathogen in both years representing (35.6 and 38.1%), followed by S. aureus (11.2 and 15.4%). Rate carbapenem-resistant K. pneumoniae insignificantly increased (25% vs 23%, p=0.3) and Methicillin-resistant S. aureus decreased (68% vs 70%, p=0.4).
Conclusions:
Egypt HAI surveillance successfully described impact of COVID-19 pandemic on HAIs. It identified significant decrease in ICU-acquired HAIs and DAIs at first pandemic year, that could reflect better infection control measures. Types of HAIs, causative pathogens and antimicrobial resistance pattern did not change significantly. Surveillance should be maintained to guide HAIs preventive and control measures.
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