Pandemic-driven transmission-based prevention as an observational scenario for multidrug-resistant organisms

Background: The coronavirus disease 2019 (COVID-19) pandemic was associated with changes in infection prevention and control (IPC) measures and antimicrobial resistance epidemiology across healthcare settings. Methods: We conducted a retrospective observational study assessing multidrug-resistant organisms (MDROs) in an Italian community hospital. The facility provides intermediate care, defined as a range of services aimed at facilitating the transition from hospital to home or long-term care. We compared the proportion of patients with infection-positive clinical cultures and MDRO-positive clinical cultures across three periods: pre-COVID-19 (January 2019 to January 2020), COVID-19 (February 2020 to March 2021) and post-COVID-19 (April 2021 to December 2023), defined according to the evolution of the disease in the Marche Region. Comparisons were performed using chi-square/Fisher exact tests and multivariable logistic regression. Results: 903 patients were included in the study; 51% had infection-positive clinical cultures, and 30% had an MDRO-positive culture. All cultures were obtained from clinical specimens collected for diagnostic purposes; no surveillance screening cultures were performed. The proportion of patients with MDRO-positive cultures differed significantly across periods and was lowest during the COVID-19 period (P = 0.013), as confirmed in the multivariable analysis (P = 0.004). Urinary catheter and pressure sores were associated with increased odds of MDRO-positive clinical cultures. Conclusions: In this cohort, the proportion of patients with MDRO-positive clinical cultures was lower during the COVID-19 period than in the post-COVID-19 period. Urinary catheter and pressure sores were independently associated with MDRO-positive clinical culture detection. This finding may reflect multiple concurrent factors, including changes in IPC practices and bed occupancy and highlight the need for continuous IPC improvements.