# Healthcare-Associated Infections Secondary to Multidrug-Resistant Organisms in Hospitalised Patients with COVID-19 Pneumonia: A single-centre experience

## TL;DR

Hospitalized patients with COVID-19 pneumonia face a high risk of infections from drug-resistant bacteria, which are strongly linked to higher death rates.

## Contribution

This study reports a significant association between MDRO infections and mortality in hospitalized patients with COVID-19 pneumonia.

## Key findings

- 15.6% of hospitalized patients with COVID-19 pneumonia developed healthcare-associated infections from MDROs.
- Pneumonia and bacteraemia were the most common infection sites linked to MDROs.
- Patients with MDRO infections had a 41.3% mortality rate compared to 3.6% in those without.

## Abstract

Hospitalisations related to COVID-19 pneumonia have increased the risk of healthcare-associated infections (HCAIs), including those caused by multidrug-resistant organisms (MDROs). This study aimed to investigate the epidemiology of HCAIs secondary to MDROs among hospitalised patients with COVID-19 pneumonia.

This retrospective study population included patients with COVID-19 pneumonia aged 18 years and older who were admitted to Sultan Qaboos University Hospital, Muscat, Oman, for more than 48 hours between March 2020 and December 2021.

A total of 486 patients were included in this study. Among the cohort, 76 patients (15.6%) were diagnosed with concurrent HCAIs with an MDRO as the causative pathogen. Of these patients, 31 (40.8%) had infections caused by MDR Acinetobacter baumannii, 15 (19.7%) had infections secondary to carbapenem-resistant Klebsiella pneumoniae and 8 (10.5%) had infections caused by extended-spectrum betalactamase Escherichia coli. Pneumonia and bacteraemia were the two most common concurrent healthcare-associated MDRO infection sites, accounting for 42% and 36% of all events, respectively. Among the 486 patients, 155 died (31.9%). Among these, 64 (41.3%) had concurrent HCAIs caused by 1 or more MDROs. Contrarily, among the 331 patients with COVID-19 pneumonia who recovered, only 12 (3.6%) had concurrent HCAIs.

There is high prevalence of healthcare-associated MDRO infections.predominantly pneumonia and bacteraemia.in hospitalised patients with COVID-19 pneumonia. This reveals a significant association between infection with MDROs and death underlining the substantial impact of infection with MDROs in this vulnerable patient population.