Impact of COVID-19 on healthcare-associated infections: Antimicrobial consumption does not follow antimicrobial resistance

Abstract Background This study aimed to analyze the Healthcare-Associated Infections (HAI) rates and antimicrobial consumption in Intensive Care Units (ICU) in São Paulo city during the COVID-19 pandemic and compare them with the pre-pandemic period. Methods This cohort included all hospitals that reported HAI rates (Central-Line-Associated Bloodstream Infection ‒ CLABSI and Ventilator-Associated Pneumonia ‒ VAP), the proportion of microorganisms that caused CLABSI, the proportion of resistant microorganisms, and antimicrobial consumption from January 2017 ‒ December 2020. Hospitals were stratified by the number of beds, Central Venous Catheter (CVC) utilization rate, Mechanical-Ventilation (MV) utilization rate, and type of funding. Statistical analyses were based on time-series plots and regression models. Results 220 ICUs were included. The authors observed an abrupt increase in CLABSI rates after the pandemic onset. High CLABSI rates during the pandemic were associated with hospital size, funding (public and non-profit private), and low CVC use (≤ 50%). An increase in VAP rates was associated with public hospitals, and high MV use (> 35%). The susceptibility profile of microorganisms did not differ from that of the pre-pandemic period. polymyxin, glycopeptides, and antifungal use increased, especially in COVID-19 ICUs. Conclusions HAI increased during COVID-19. The microorganisms' susceptibility profile did not change with the pandemic, but the authors observed a disproportionate increase in large-spectrum antimicrobial drug use.

Infecção pelo HIV, hepatites B e C e sífilis em moradores de rua, São Paulo / HIV infection, hepatitis B and C and syphilis in homeless people, in the city of São Paulo, Brazil / HIV infection, hepatitis B and C and syphilis in homeless people, in the city of São Paulo, Brazil

OBJETIVO: Estimar a prevalência das infecções pelo HIV, vírus das hepatites B e C, e da sífilis em moradores de rua. MÉTODOS: Estudo transversal com intervenção educativa, realizado no município de São Paulo, de 2002 a 2003. Selecionou-se amostra de conveniência de moradores de rua que utilizavam albergues noturnos, segundo os critérios: >18 anos e não apresentar distúrbios psiquiátricos. Em entrevistas, foram coletados dados sociodemográficos e de comportamento, e realizados exames laboratoriais para HIV, hepatite B e C e sífilis, e aconselhamento pós-teste. RESULTADOS: Participaram 330 usuários dos albergues, com 40,2 anos (média), 80,9 por cento homens, nas ruas, em média, há um ano. Observaram-se prevalências de 1,8 por cento de HIV, 8,5 por cento de vírus de hepatite C, 30,6 por cento de infecção pregressa por hepatite B, 3,3 por cento de infecção aguda ou crônica pelo vírus hepatite B e 5,7 por cento de sífilis. Uso consistente de preservativo foi referido por 21,3 por cento e uso de droga injetável, por 3 por cento dos entrevistados. A positividade para HIV foi de 10 por cento e 50 por cento para vírus da hepatite C entre usuários de drogas injetáveis, versus 1,5 por cento para HIV e 7,3 por cento para hepatite C nos demais, evidenciando associação entre esse vírus e uso de droga injetável. Prisão anterior foi referida por 7,9 por cento das mulheres e 26,6 por cento dos homens, com prevalência de 2,6 por cento para HIV e 17,1 por cento para vírus da hepatite C. CONCLUSÕES: As elevadas prevalências de HIV e vírus de hepatite B e C requerem programas de prevenção baseados na vacinação contra hepatite B, diagnóstico precoce dessas infecções e inserção dos moradores de rua em serviços de saúde.

OBJECTIVE: To estimate the prevalence of HIV infections, as well as hepatitis B and C and syphilis viruses in homeless people. METHODS: Cross-sectional study with educational intervention, conducted in the city of São Paulo, between 2002 and 2003. A convenience sample of homeless people who used night shelters was selected, according to the following criteria: aged 18 or older and not showing psychiatric disturbances. During interviews, sociodemographic and behavioral data were gathered and HIV, hepatitis B and C and syphilis laboratorial tests and post-test counseling were carried out. RESULTS: A total of 330 shelter users participated, with an average age of 40.2 years, 80.9 percent of them male, having lived on the streets for one year in average. Prevalences of 1.8 percent for HIV, 8.5 percent for hepatitis C virus, 30.6 percent for previous hepatitis B infection, 3.3 percent for chronic or acute infection by hepatitis B virus, and 5.7 percent for syphilis. The consistent use of condoms was referred to by 21.3 percent of interviewees and the use of injecting drugs by 3 percent of them. Positivity was 10 percent for HIV and 50 percent for hepatitis C virus among injectable drug users, versus 1.5 percent for HIV and 7.3 percent for hepatitis C among the others, showing an association between the virus and the use of injecting drugs. Previous imprisonment was referred to by 7.9 percent of women and 26.6 percent of men, with a prevalence of 2.6 percent for HIV and 17.1 percent for hepatitis C virus. CONCLUSIONS: The high prevalences of HIV and hepatitis B and C viruses require prevention programs based on vaccination against hepatitis B, early diagnosis of these infections and placement of homeless people into health services.