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Carbapenem resistance rates in critically ill hospital patients in Brazil rose during the COVID-19 pandemic and have remained higher than pre-pandemic rates, researchers reported last week in the American Journal of Infection Control.

For the study, researchers retrospectively analyzed data on all critically ill, mechanically ventilated adults admitted to eight Brazilian hospitals from January 1, 2018, to April 30, 2023, stratifying the patients into three periods: pre-surge (January 1, 2018, to March 1, 2020), surge (March 1, 2020, to October 1, 2021), and post-surge (after October 1, 2021). The main outcome was the number of carbapenem-resistant gram-negative bacterial isolates across the three periods. 

Brazil had one of the highest COVOD-19 burdens in the world, and notable increases in carbapenem use in Brazilian hospitals during the early months of the pandemic have previously been reported.

Concerns about resistance rates remaining ‘permanently high’

Of the 9,780 patients included in the study, 3,718 were in the pre-surge, 3,185 in the surge, and 2,247 in the post-surge period. The patients in the pre- and post-surge periods had similar characteristics and outcomes, while the patients in the surge period were younger (median age, 70 vs 74 pre-surge vs 75 post-surge), mainly male (57% vs 48% vs 51%), and had higher rates of mechanical ventilation (7 vs 5 days pre- and post-surge). 

The isolation of carbapenem-resistant gram-negative bacteria increased during the surge (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.5 to 2.2 compared to pre-surge), decreased in post-surge (RR, 0.72; 95% CI, 0.6 to 0.9), and remained higher than pre-surge (RR, 1.3; 95% CI, 1.0 to 1.6). Resistance rates for Pseudomonas aeruginosa fell from 32% to 23% pre- to post-surge, whereas Klebsiella pneumoniae doubled during the surge, 26% to 52%, and remained higher (42%) than pre-surge. 

“In a post-COVID-19 world, with the emergence of new infectious diseases and ongoing challenges posed by existing pathogens, the importance of preserving the effectiveness of antimicrobials cannot be overstated,” the study authors wrote. “It is necessary to coordinate efforts to avoid antimicrobial resistance rates remaining permanently high and to prevent future similar antimicrobial stewardship breakdowns.”