Impact of the COVID-19 Pandemic on Multidrug-Resistant Organism Infections in Infected Pancreatic Necrosis: A Post-Hoc Cohort Analysis.

Background: This study aimed to elucidate the impact of COVID-19 pandemic on multidrug-resistant organism (MDRO) infection in patients with infected pancreatic necrosis (IPN).

Methods: This post-hoc analysis of a prospective cohort included patients with IPN stratified into three phases: pre-pandemic (2016-2019), pandemic period (2020-2022), and post-pandemic period (2023-2024). Logistic regression and interrupted time-series analysis (ITSA) were employed to identify risk factors and longitudinal trends.

Results: MDRO infection decreased significantly during the pandemic period compared to pre-pandemic levels (44.8% vs 81.1%, P<0.001). There was no significant difference in the incidence of MDRO infection between the pandemic and post-pandemic period (44.1% vs 44.8%, P=0.924). During the pandemic, both prophylactic antimicrobial usage (64.8% vs 85.1%, P<0.001) and ICU stays (median: 6.0 vs 15.0 days, P<0.001) were significantly reduced compared to the pre-pandemic period. Logistic regression identified prophylactic antimicrobial usage (OR 17.28, P<0.001), ICU stays (OR 1.07, P<0.001), and the COVID-19 pandemic (OR 0.21, P<0.001) as independent factors associated with MDRO infection. ITSA revealed a significant decrease in the trend of MDRO infection during the pandemic compared to the pre-pandemic period (P=0.006). An immediate level of MDRO infection increased during the post-pandemic period compared to the pandemic (P=0.040). The similar trend variations were observed in the proportion of prophylactic antimicrobial usage.

Conclusion: The COVID-19 pandemic has led to a notable reduction in MDRO infection among IPN patients, likely attributable to stringent infection prevention and control measures which led to reduced prophylactic antimicrobial usage and ICU stays during this period.