Change in Healthcare-Associated Infections Before and After the COVID-19 Pandemic

Introduction: Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide and in our country. Hand hygiene, cleaning, sterilization, disinfection, epidemiological methods, isolation measures, and surveillance studies constitute the basis of the prevention and control of HAI. In this study, we aimed to evaluate the impact of the COVID-19 pandemic on the incidence of HAIs within the framework of measures implemented in our hospital. Additionally, we sought to assess the effect of increased antibiotic use during the pandemic on the distribution and antibiotic resistance of microorganisms causing HAIs, and to contribute to epidemiological data. Materials and Methods: The study evaluated 1.089 HAI episodes in 827 patients who developed HAIs while hospitalized in Selcuk University Faculty of Medicine Hospital intensive care units (ICUs) over two periods: the two years before the COVID-19 pandemic (January 2018 to March 2020) and the two years after the onset of the pandemic (March 2020 to January 2022). All patients aged 18 years and older who developed an HAI during their follow-up in the ICU and patients who developed an HAI during their stay in the COVID-19 ICU were included in the study. Results: When evaluating the rate of HAIs developed in patients hospitalized in our hospital's ICUs during the pre-COVID-19 and post-COVID-19 periods, a decrease in HAIs was observed in the post-COVID-19 period (p= 0.001). When evaluating microorganisms grown in culture, a decrease in gram-positive growth and an increase in gram-negative growth were found in the post-COVID-19 period (p= 0.003). In examining the overall distribution of HAIs identified in the pre- and post-COVID-19 periods, pneumonia ranked first, with a significant increase in the development of pneumonia observed in the post-COVID-19 period (p= 0.001). In a separate evaluation of antibiotic susceptibilities of microorganisms, an increase in carbapenem resistance in Klebsiella spp. and quinolone and extended spectrum beta-lactamase resistance in Pseudomonas spp. isolates in the post-COVID-19 period was notable (p= 0.001). A significant increase in HAI-related mortality was observed in the post-COVID-19 period (p= 0.003). Conclusion: In conclusion, our study found that the HAI rate decreased during the pandemic period compared to the pre-pandemic period. However, there was an increase in antibiotic resistance in Klebsiella spp. and Pseudomonas spp. It is well-known that the development of HAIs increases mortality, and the more frequent occurrence of resistant microorganisms as causative agents raises concern. This underscores the importance of continuous education and surveillance in infection control policies.