MICROBIAL LANDSCAPE PATIENTS IN ICU DURING THE COVID-19 PANDEMIC

Introduction. With the onset of the pandemic, the composition of patients in the departments of anesthesiology and intensive care (OA&R) has changed, as well as the nature and volume of intensive care that can affect the microbial spectrum.
The aim of the study is a comparative analysis of the microbial spectrum and sensitivity of microorganisms to antibiotics in patients with OA&R in the dock and covid periods.
Methods. Two groups of patients of the OA&R of the Regional Infectious Diseases Clinical Hospital were examined in the dock (319 patients) and covid (179 patients) periods. 1237 bacteriological studies of biological material and determination of the sensitivity / resistance of the isolated strains to antibiotics were carried out.
Results. The duration of treatment in the covid period was 2 times longer than in the first period, in which 6 died, in the covid period - 52 patients. The number of bacteriological studies in the second period was 2 times more, despite the smaller number of patients. More often, pathogens were excreted from urine, nasopharynx, blood, in the 1st period from the cerebrospinal fluid, in the 2nd period - from sputum.
Among the pathogens in both periods, E. coli, Pr. mirabilis, St. aureus, Ps. aeruginosa, St. haemolyticus, Ent. fecalis, S. enteritidis, Sp. paucimobilis, St. hominis, Kl. pneumonia, Ac. baumani, Morganella spp., Citr. Freundi, only in the 2nd period - St. pneumonia, Streptococcus spp., Enterobacteriaceae and Enrerococcus groups, Ent. faecium, St. sciuri. The analysis of microflora in 52 patients who died from COVID-19 showed the predominance of the ESKAPE microbial spectrum: Ent.faecium and Ent. faecalis (7.9%), St. aureus (5.7%), Cl. pneumonia (25%), Ac. baumanii (5.7%), Ps. aeruginosa (3.8%), genus Enterobacter 7.9%). Significant differences in the resistance of the isolated flora to antibiotics and the formation of multiresistance to the covid period were noted.
Conclusions. The COVID-19 pandemic has changed the structure of the bacteriological spectrum in OA&R patients. The use of antibiotics led to an increase in the hospital strains presented by the ESKAPE group, an increase in resistance and multidrug resistance, which was one of the reasons for the decrease in the effectiveness of treatment. An additional reason for the growth of nosocomial strains is the congestion of OA&R with COVID-19 patients requiring respiratory support.

1. COVID-19: what has been learned and to be learned about the novel coronavirus disease / Y. Yi, P.N.P. Lagniton, S. Ye [et al.] // Int J Biol Sci. – 2020. – Vol. 16 (10). – P. 1753–1766. doi:10.7150/ijbs.45134.

2. Alekshun, M.N. Molecular mechanisms of antibacterial multidrug resistance / M.N. Alekshun, S.B. Levy // Cell. – 2007. – Vol. 128. – P.1037-1050. doi: 10.1016/j.cell.2007.03.004. PMID: 17382878.

3. Antimicrobial Resistance in ESKAPE Pathogens / D.M.P. De Oliveira, B.M. Forde, T.J, Kidd [et al.] // Clin Microbiol Rev. – 2020. – Vol. 33 (3): e00181-19. doi: 10.1128/CMR.00181-19. PMID: 32404435; PMCID: PMC7227449.

4. Liu J.Y., Dickter J.K. Nosocomial Infections: A History of Hospital-Acquired Infections / J.Y. Liu, J.K. Dickter // Gastrointest Endosc Clin N Am. – 2020. – Vol. 30(4). – P. 637-652. doi: 10.1016/j.giec.2020.06.001. Epub 2020 Jul 30. PMID: 32891222.

5. Smith P.W. Infection control through the ages / P.W. Smith, K. Watkins, A. Hewlett // Am J Infect Control. – 2012. – Vol. 40 (1). – P. 35-42. doi: 10.1016/j.ajic.2011.02.019. Epub 2011 Jul 23. PMID: 21783278.

6. Prevalence of Antibiotic Resistance of ESKAPE Pathogens Over Five Years in an Infectious Diseases Hospital from South-East of Romania / M. Arbune, G. Gurau, E. Niculet [et al.] // Infect Drug Resist. – 2021. – Vol. 14. – P. 2369-2378. doi: 10.2147/IDR.S312231. PMID: 34194233; PMCID: PMC8238535.

7. Prestinaci F., Antimicrobial resistance: a global, multifaceted phenomenon / F. Prestinaci, P. Pezzotti, A. Pantosti // Pathog Glob Health. – 2015. – Vol. 109 (7). – P. 309–318. doi:10.1179/2047773215Y.0000000030.

8. Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome / T. Bardi, V. Pintado, M. Gomez-Rojo [et al.] // Eur J Clin Microbiol Infect Dis. – 2021. – Vol. 40 (3). – P. 495-502. doi: 10.1007/s10096-020-04142-w. Epub 2021 Jan 3. PMID: 33389263; PMCID: PMC7778834.