key: cord-288980-kig6xnkb
authors: Donà, Daniele; Di Chiara, Costanza; Sharland, Mike
title: Multidrug resistant infections in the COVID-19 era, a framework for considering the potential impact
date: 2020-05-17
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2020.05.020
sha: 
doc_id: 288980
cord_uid: kig6xnkb

nan

The recent report by Jolivet et al highlights the progress being made on Multidrug-resistant (MDR) infections [1] . However, this report predates the COVID-19 pandemic and it is unclear what the impact will be on MDR infections globally. There are reports of a high use of broad-spectrum antibiotics in the hospital setting, recognised as a risk factor for hospital-acquired infections (HAI) with MDR organisms [2] [3] [4] . Recent data have also pointed to significant rates of hospital-acquired pneumonia (HAP) [2] . High rates of admission, shortages of staff and personal protective equipment (PPE) and high acuity patients with prolonged lengths of stay in overcrowded facilities may also impact on rates of HAI with MDR pathogens [2, 3] . Moreover, severe COVID-19, which particularly affects elderly patients with multiple comorbidities, may be an important factor in determining changes of colonization pressure [2] [3] [4] . Equally, wider recognition of the importance of nosocomial infections, with stricter hygiene policies, high use of PPE, and patients being cared for in new temporary hospitals, could all mitigate against this threat [2, 3] . We have tried to summarise in Table I the potential relative impact of these various factors to provide a conceptual framework for determining the overall impact [2] [3] [4] [5] [6] .

Novel cost-effective surveillance programmes of MDR HAI in both high-and low/middle-income countries will be even more important in the post COVID-19 era, combined with enhanced stewardship interventions.

These need to be planned for now, to facilitate future integration with any future pandemic surveillance.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors. [2] [3] [4] Lower rates of admission to hospital from long term care facilities may lead to less transmission cycles between long term care facilities and hospitals [2] [3] [4] 

Impact of colonisation pressure on acquisition of extendedspectrum β-lactamase-producing Enterobacteriaceae and meticillin-resistant Staphylococcus aureus in two intensive care units: a 19-year retrospective surveillance

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. The Lancet. Respiratory medicine

Management of multidrug-resistant organisms in health care settings

Critical care response to a hospital outbreak of the 2019-nCoV infection in Shenzhen

Bed occupancy rates and hospital-acquired infections--should beds be kept empty