Covid-19 and the risk of infections caused by multidrug-resistant organisms: a retrospective cohort study in a community hospital

SESSION TITLE: COVID and Other Viruses: More Lessons From the Tridemic SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: The link between COVID-19 and an elevated usage of antibiotics is well established, with several studies suggesting that up to 70-97% of patients are exposed to these medications. Furthermore, numerous hospitals worldwide have reported a surge in infections caused by multidrug-resistant organisms (MDROs) during the pandemic. However, whether COVID-19 itself is a contributing factor to this trend remains an area of limited research. METHODS: We conducted a workbench report to identify patients who were admitted to the ICU of our community hospital in Evanston, Illinois, between January 1, 2018, and January 31, 2022, and had positive cultures for blood, urine, sputum, or wound samples. We also identified the number of patients who tested positive for COVID-19 infection during their ICU stay. To evaluate the rate of bacterial co-infections in these patients, we utilized logistic regression, which was adjusted for the baseline characteristics of the patients. RESULTS: In this study, a total of 591 patients with positive cultures were analyzed, with MDROs being isolated only in 228 of them. Consistent with previous research, major risk factors for MDROs included living in a skilled nursing facility, having a history of MDROs, and recent hospitalization with antibiotic exposure. Of the patients with cultures positive for MDROs, 195 (85.5%) were from a nursing facility (p < 0.001), 93 (40.8%) had a history of MDROs in the past year (p <0.001), and 145 (63.6%) had been hospitalized and exposed to antibiotics within the past 90 days. Age, HIV, and immunosuppression did not emerge as significant risk factors (p >0.05). Out of the total 248 patients with COVID-19, bacterial co-infection was present in 47 (18.9%), excluding possible and likely contaminants. Of these 47 patients, only 4 (8.5%) had grown MDROs. However, all of these patients had more than two major risk factors for MDRO infection. The most common isolates identified were ESBL (17.1%), CRE (7.9%), VRE (4.4%), MRSA (4.8%), and Acinetobacter (8.8%). CONCLUSIONS: Our study revealed a weak association between COVID-19 and MDROs, indicating a low correlation between the two. However, the incidence of bacterial co-infection was higher (18.9%) than the rate reported by the CDC, which is less than 10%. Notably, over 90% of patients with COVID-19 received steroid treatment, and around 70% were exposed to antibiotics. CLINICAL IMPLICATIONS: It's worth mentioning that a limitation of our study was the exclusion of patients with prior hospitalization for COVID-19. As such, it remains unclear whether there is an association between COVID-19 and the future risk of MDRO infection. Further research is needed to explore this potential link. DISCLOSURES: No relevant relationships by Maria Abu Nseir No relevant relationships by Valiko Begiashvili No relevant relationships by Jaeyoun Choi No relevant relationships by Goar Egoryan No relevant relationships by Armen Kishmiryan No relevant relationships by Qingqing Meng No relevant relationships by Akshaya Ramachandran No relevant relationships by Guillermo Rodriguez-Nava No relevant relationships by Stjepan Surbek