Surging bloodstream infections and antimicrobial resistance during the first wave of COVID-19: a study in a large multihospital institution in the Paris region

Amarsy, Rishma; Trystram, David; Cambau, Emmanuelle; Monteil, Catherine; Fournier, Sandra; Oliary, Juliette; Junot, Helga; Sabatier, Pierre; Porcher, Raphaël; Robert, Jérôme; Jarlier, Vincent

Objectives We measured the impact of the first wave of COVID-19 (March-April 2020) on the incidence of bloodstream infections (BSIs) during at the Assistance Publique - Hôpitaux de Paris (APHP), the largest multisite public healthcare institution in France. Methods The number of patient admissions blood cultures (BCs) collected, positive BCs as well as antibiotic resistance and consumption was retrospectively analyzed for the first quarter of 2020, and of 2019 for comparison, in 25 APHP hospitals (ca. 14,000 beds). Results Up to a fourth on patients admitted in March-April 2020 in these hospitals had COVID-19. BSI rate per 100 admissions increased globally, by 24% in March and 115% in April 2020, and separately for the major pathogens (Escherichia coli, Klebsiella pneumoniae, enterococci, Staphylococcus aureus, Pseudomonas aeruginosa, yeasts). A sharp increase in the rate of BSIs caused by microorganisms resistant to 3rd generation cephalosporins (3GC) was also observed in March-April 2020, particularly in K.pneumoniae, in enterobacterial species naturally producing inducible AmpC (Enterobacter cloacae...) and P.aeruginosa. A concomitant increase occurred in 3GC consumption. Conclusions COVID-19 pandemic had a strong impact on hospital management and also unfavorable effects on severe infections, antimicrobial resistance and laboratory work diagnostics.