During the COVID-19 pandemic, hospital-onset antimicrobial-resistant (AMR) infections increased by 6.5% and remained 11.6% above baseline by March 2022.
RT’s Three Key Takeaways:
- Pandemic-Driven Rise in AMR: Antimicrobial-resistant (AMR) infections in hospitals increased by 6.5% during the COVID-19 pandemic, largely driven by patient factors like greater illness severity and prior antibiotic exposure rather than hospital-specific factors.
- Hospital-Onset Infections Persisted: While community-onset AMR infections returned to baseline levels after March 2022, hospital-onset AMR infections remained 11.6% above baseline, signaling ongoing challenges in healthcare settings.
- Shifts in Infection Patterns: MRSA infections declined during the pandemic, but carbapenem-resistant Acinetobacter (CRAB) infections rose the most, highlighting a changing landscape of AMR threats that will require tailored infection control strategies moving forward.
A retrospective cohort study found that antimicrobial resistant (AMR) infections increased in hospitals during the pandemic due to non-hospital factors, including increased illness severity and antibiotic exposure in the 3 months prior to hospitalization. The findings are consistent with a recent Centers for Disease Control and Prevention fact sheet on AMR. The researchers say their study could inform ongoing control interventions and improve responses to future crises. The study is published in Annals of Internal Medicine.
Researchers from the National Institutes of Health Clinical Center and colleagues queried PINC AI to sort data from 243 U.S. hospitals between January 2018 and December 2022 to determine incidence of AMR infection and contributing factors among adult patients. They analyzed infections during three time periods: prepandemic (January 2018 to December 2019), peak pandemic (March 2020 to February 2022), and waning pandemic (March to December 2022).
Encounters were screened for cultures from any source with growth of Staphylococcus aureus, Enterococcus species, Acinetobacter species, Pseudomonas aeruginosa, or Enterobacterales. The AMR phenotypes analyzed included: methicillin-resistant S aureus (MRSA), vancomycin resistant Enterococci (VRE), extended-spectrum cephalosporin-resistant (carbapenem-susceptible) Enterobacterales (ECR-E), carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant P aeruginosa (CR-PA), and carbapenem-resistant Acinetobacter (CRAB).
The researchers also conducted a competing risks analysis to investigate the effects of patient- and hospital-level characteristics on the risk of hospital-onset AMR infection.
The researchers found that of the 9,955,696 hospitalizations, there were 178,579 infection episodes associated with 1 of the 6 AMR phenotypes, equivalent to an overall incidence of 179.4 per 10,000 hospitalizations.
MRSA infections were the most common overall, but CRAB infections increased the most during the pandemic. MRSA infections decreased during the pandemic and continued declining throughout 2022.
VRE, CR-PA, CRE, and CRAB represented relatively greater proportions of hospital-onset infections. Overall AMR infections increased by 6.5% during the pandemic and returned to baseline levels after March 2022.
Hospital-based infections had larger increases than community-based infections during the pandemic, and as the pandemic waned, community-onset AMR returned to baseline levels whereas hospital-onset AMR remained 11.6% above the baseline.
Patient factors were most associated with higher hospital-onset AMR infections during the pandemic including acute illness severity. Additionally, antibiotic exposure in the prior 3 months was incrementally associated with an increased risk for hospital-onset AMR infections.
