Healthcare-associated infections in patients with COVID-19: is it different from the pre-pandemic period?

Introduction: Healthcare-associated infections (HAIs) are common in intensive care unit (ICU) patients and may cause devastating consequences. However, the prevalence of HAI and its effects on in-hospital mortality among critically ill COVID-19 patients is ambiguous. We determined the prevalence of HAI and the rate of mortality in critically ill COVID-19 patients and compared it with pre-pandemic ICU patients.

Methodology: This retrospective study was conducted with adult ICU patients admitted to Gazi Yaşargil Training and Research Hospital (Diyarbakir,Turkey) in April-November 2019 (defined as the pre-pandemic period) and in April-November 2020 (defined as the pandemic period). All patients in the pandemic period had COVID-19, while none in the pre-pandemic period did. Patients diagnosed with HAIs during the in-hospital follow-up period were recorded.

Results: Of 4596 enrollees, 3386 (73.7%) were pandemic-period patients and 1210 (26.3%) were pre-pandemic-period patients. HAI prevalence was significantly higher at 5.9% (n = 71) in the pandemic-period patients and 2.7% (n = 91) in the pre-pandemic-period patients (p < 0.001). Comorbidities including hypertension (63.4% vs 14.2%, p < 0.001), diabetes mellitus (39.4% vs 8.8%, p < 0.001), and coronary artery disease (30.9% vs 10.9%, p = 0.002) were significantly more frequent in pandemic-period HAI-positive patients. The most common HAI was catheter-related bloodstream infection in both groups, with similar frequency (p = 0.652). In-hospital mortality rate was 85.9% versus 65.9% in pandemic- versus pre-pandemic-period HAI-positive patients (p < 0,05).

Conclusions: The prevalence of HAI and the in-hospital mortality rate was significantly higher among pandemic-period patients.