Persistent carbapenem resistance in mechanically ventilated ICU patients: A before-and-after analysis of the COVID-19 surge

Background: The evolution of antimicrobial resistance among critically ill patients before, during, and after the COVID-19 surge remains unclear. Methods: We retrospectively analyzed critically ill mechanically ventilated adult patients admitted to 8 Brazilian hospitals from Jan 1, 2018 to Apr 30, 2023. We stratified the patients into 3 periods: pre-surge (Jan 01, 2018-Mar 01, 2020), surge (Mar 01, 2020-Oct 01, 2021), and post-surge (after October 01, 2021). Positive cultures, pathogen prevalence, and resistance rates were analyzed using rate ratios (RR) with 95% confidence intervals (CI). Results: Among 9,780 patients (3,718 pre-surge, 3,815 surge, 2,247 post-surge), those in surge period were younger (median: 70 vs 74 pre-surge vs 75 post surge) and had longer invasive mechanical ventilation duration (median 7 vs 5 days). Blood and respiratory cultures increased across periods (56.9 pre-surge vs 69.4 surge vs 70.4 patients/1,000 patient-days post-surge). Isolation of carbapenem-resistant gram-negatives increased during the surge (RR [95% CI]: 1.8 [1.5-2.2], decreased in post-surge (0.72 [0.6-0.9]), and remained higher than pre-surge (1.3 [1.0-1.6]). Resistance rates for Pseudomonas aeruginosa reduced in postsurge, whereas Klebsiella pneumoniae doubled during the surge, and remained elevated. Conclusions: Carbapenem resistance increased during the surge period. Although it decreased post-surge, it remained higher than pre-pandemic rates. (c) 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.