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The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit
Jale Boral1,2, Zeliha Genç3, Fatihan Pınarlık1,2
1Graduate School of Health Sciences, Koç University, Istanbul, Turkey.
Abstract:
We aimed to describe the increased rate of Acinetobacter baumannii infections during the COVID-19 pandemic and define its significance within the last five years. This study was performed in a tertiary hospital with 280 beds and included all patients infected with A. baumannii in the intensive care unit between January 1, 2018, and June 30, 2022. A. baumannii-infected patients in the intensive care unit 27 months before the pandemic and 27 months during the pandemic were included. Pulsed-field gel electrophoresis was performed to assess clonal relatedness. The infection control measures were specified based on the findings and targeted elimination. In total, 5718 patients were admitted to the intensive care unit from January 1st, 2018, to June 30th, 2022. A. baumannii infection was detected in 81 patients. Compared to the pre-pandemic era, the rate of A. baumannii infection during the pandemic was 1.90 times higher (OR: 1.90, 95% CI: [1.197, 3.033]). Clonality assessment of multidrug-resistant A. baumannii samples revealed eight clusters with one main cluster comprising 14/27 isolates between 2021 and 2022. The case fatality rate of the pre-pandemic and pandemic era was not different statistically (83.33% vs. 81.48%, p = 0.835). Univariate analysis revealed the association of mechanical ventilation (p = 0.002) and bacterial growth in tracheal aspirate (p = 0.001) with fatality. During the COVID-19 pandemic, potential deficits in infection control measures may lead to persistent nosocomial outbreaks. In this study, the introduction of enhanced and customized infection control measures has resulted in the containment of an A. baumannii outbreak.
Insights
Acinetobacter baumannii infections significantly increased during the COVID-19 pandemic, nearly doubling the infection rate. Enhanced infection control measures were crucial in containing these outbreaks.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The COVID-19 pandemic presented challenges to healthcare systems, potentially impacting nosocomial infections.
- Acinetobacter baumannii is a significant opportunistic pathogen, particularly in intensive care units (ICUs).
Purpose of the Study:
- To investigate the incidence and characteristics of Acinetobacter baumannii infections in an ICU setting during the COVID-19 pandemic.
- To compare infection rates and outcomes between the pre-pandemic and pandemic periods.
- To evaluate the effectiveness of infection control measures in managing A. baumannii outbreaks.
Main Methods:
- Retrospective analysis of A. baumannii infections in a 280-bed tertiary hospital ICU from January 2018 to June 2022.
- Inclusion of patients from 27 months pre-pandemic and 27 months during the pandemic.
- Pulsed-field gel electrophoresis (PFGE) for assessing clonal relatedness of isolates.
Main Results:
- The rate of A. baumannii infection was 1.90 times higher during the pandemic compared to the pre-pandemic era (OR: 1.90).
- Multidrug-resistant A. baumannii isolates formed eight clusters, with a predominant cluster identified between 2021-2022.
- Case fatality rates were similar between the two periods (83.33% vs. 81.48%), with mechanical ventilation and tracheal aspirate bacterial growth associated with mortality.
Conclusions:
- The COVID-19 pandemic was associated with a nearly twofold increase in A. baumannii ICU infections, suggesting potential deficits in infection control.
- Despite similar fatality rates, the increased incidence highlights the need for vigilant surveillance and control.
- Implementation of enhanced, customized infection control measures successfully contained an A. baumannii outbreak.
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