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Epidemiology of multidrug-resistant organisms before and during COVID-19 in Hong Kong
Shuk-Ching Wong1, Pui-Hing Chau2, Simon Yung-Chun So3
1Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China.
Background:
The coronavirus disease 2019 (COVID-19) has influenced antimicrobial consumption and incidence of multidrug-resistant organisms (MDROs). We aimed to study the epidemiology of MDROs before and during the COVID-19 pandemic in Hong Kong.
Methods:
With the maintenance of infection control measures, we described the trend of MDRO infections, including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum-beta-lactamase-(ESBL)-producing Enterobacterales, in a healthcare region with 3100-bed before (1 January 2016 to 31 December 2019, period 1) and during COVID-19 (1 January 2020 to 30 September 2022, period 2), together with the antimicrobial consumption using piecewise Poisson regression. The epidemiological characteristics of newly diagnosed COVID-19 patients with or without MDRO infections were analyzed.
Results:
Between period 1 and 2, we observed a significant increase in the trend of CRA infections (P<0.001), while there was no significant increase in the trend of MRSA (P=0.742) and ESBL-producing Enterobacterales (P=0.061) infections. Meanwhile, a significant increase in the trend of carbapenems (P<0.001), extended-spectrum beta-lactam-beta-lactamase inhibitor combinations (BLBI) (P=0.045), and fluoroquinolones (P=0.009) consumption was observed. The observed opportunity (23,540 ± 3703 vs 26,145 ± 2838, p=0.359) and compliance (81.6% ± 0.5% vs 80.1% ± 0.8%, P=0.209) of hand hygiene per year was maintained. In a multivariable model, older age, male sex, referral from residential care home for the elderly, presence of indwelling device, presence of endotracheal tube, and use of carbapenems, use of BLBI, use of proton pump inhibitors and history of hospitalization in the past 3 months were associated with higher risks of infections by MDROs among COVID-19 patients.
Conclusion:
Infection control measures may control the surge of MDROs despite an increasing trend of antimicrobial consumption.
Insights
The COVID-19 pandemic saw increased carbapenem-resistant Acinetobacter infections and antimicrobial use, despite maintained infection control. This highlights the need for continued vigilance against multidrug-resistant organisms (MDROs).
Area of Science:
- Infectious Diseases
- Epidemiology
- Antimicrobial Stewardship
Background:
- The COVID-19 pandemic significantly impacted healthcare, influencing antimicrobial consumption and the prevalence of multidrug-resistant organisms (MDROs).
- Understanding these changes is crucial for effective infection control and antimicrobial stewardship.
- Hong Kong's healthcare system experienced these shifts, necessitating a detailed epidemiological study.
Purpose of the Study:
- To investigate the epidemiological trends of MDROs before and during the COVID-19 pandemic in Hong Kong.
- To analyze changes in antimicrobial consumption patterns in conjunction with MDRO incidence.
- To identify risk factors for MDRO infections among COVID-19 patients.
Main Methods:
- A retrospective study comparing MDRO infections (MRSA, CRA, ESBL-producing Enterobacterales) and antimicrobial consumption before (2016-2019) and during (2020-2022) the COVID-19 pandemic.
- Piecewise Poisson regression was used to analyze trends in MDROs and antimicrobial use.
- Epidemiological characteristics of COVID-19 patients with and without MDRO infections were analyzed using multivariable models.
Main Results:
- A significant increase in carbapenem-resistant Acinetobacter (CRA) infections (P<0.001) was observed during the pandemic.
- Antimicrobial consumption of carbapenems, BLBI, and fluoroquinolones also significantly increased.
- Hand hygiene compliance remained high, and risk factors for MDROs in COVID-19 patients included older age, male sex, and indwelling devices.
Conclusions:
- Despite increased antimicrobial consumption, robust infection control measures appeared to mitigate a surge in most MDROs.
- Carbapenem-resistant Acinetobacter species represent a growing concern requiring targeted interventions.
- Continued monitoring and adherence to infection control protocols are essential for managing MDROs in the context of pandemics.
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