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SG-APSIC1097: The impact of COVID-19 on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore: An interrupted time-series analysis

Published online by Cambridge University Press:  16 March 2023

Chong Hui Clara Ong
Affiliation:
National Centre for Infectious Diseases, Singapore
Thoon Koh Cheng
Affiliation:
Paediatrics Infectious Diseases Service, K K Women’s and Children’s Hospital, Singapore
Surinder Kaur M S Pada
Affiliation:
Medicine, Infectious Diseases, Ng Teng Fong General Hospital, Singapore
Deepak Rama Narayana
Affiliation:
Laboratory Medicine, Khoo Teck Puat Hospital, Singapore
Say Tat Ooi
Affiliation:
General Medicine, Khoo Teck Puat Hospital, Singapore
Nares Smitasin
Affiliation:
Medicine, National University Hospital, Singapore
Kok Choon Raymond Fong
Affiliation:
Infectious Diseases, Changi General Hospital, Singapore
Tse Hsien Koh
Affiliation:
Microbiology, Singapore General Hospital, Singapore
Pei Zhi Benjamin Cherng
Affiliation:
Infectious Diseases, Singapore General Hospital, Singapore
Raymond Lin
Affiliation:
National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
De Partha Pratim
Affiliation:
Laboratory Medicine, Tan Tock Seng Hospital, Singapore
Hsu Li Yang
Affiliation:
Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Jeanette Teo
Affiliation:
CSS Laboratory Medicine, National University Hospital, Singapore
Oon Tek Ng
Affiliation:
Infectious Diseases, Tan Tock Seng Hospital, Singapore
Indumathi Venkatachalam
Affiliation:
Infection Prevention & Epidemiology and Infectious Diseases, Singapore General Hospital, Singapore
Kalisvar Marimuthu
Affiliation:
Infectious Diseases, Tan Tock Seng Hospital, Singapore

Abstract

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Objectives: Over the past 2 years, many infection prevention and control (IPC) resources have been diverted to manage the COVID-19 pandemic. Its impact on the incidence of antimicrobial-resistant organisms has not been adequately studied. We investigated the impact of the pandemic on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore. Methods: We extracted data on unique CRE isolates (clinical and/or surveillance cultures) and patient days for 6 public hospitals in Singapore from the carbapenemase-producing Enterobacteriaceae (CaPES) study group database, and we calculated the monthly incidence of CRE (per 10,000 patient days). Interrupted time-series (ITS) analysis was conducted with the pre–COVID-19 period defined as before February 2020, and the COVID-19 period defined as after February 2020. Statistical analyses were performed using Stata version 15 software. Results: From January 2017 to March 2021, 6,770 CRE isolates and 9,126,704 patient days were documented. The trend in CRE monthly incidence increased significantly during the pre–COVID-19 period (0.060; 95% CI, 0.033–0.094; P < .001) but decreased during the COVID-19 period (−0.183; 95% CI, −0.390 to 0.023; P = .080) without stepwise change in the incidence (−1.496; 95% CI, −3.477 to 0.485; P = .135). The trend in monthly incidence rate of CRE clinical cultures increased significantly during the pre–COVID-19 period (0.046; 95% CI, 0.028–0.064; P < .001) and decreased significantly during COVID-19 period (−0.148; 95% CI, −0.249 to −0.048; P = .048) with no stepwise change in the incidence (−0.063; 95% CI, −0.803 to 0.677; P = .864). The trend in monthly incidence rate of CRE surveillance cultures decreased during the pre–COVID-19 period (−0.020; 95% CI, −0.062 to 0.022; P = .341) and the COVID-19 period (−0.067; 95% CI, −0.291to 0.158; P = .552) without stepwise change in the incidence (−1.327; 95% CI, −3.535 to 0.881; P = .233). Conclusions: The rate of CRE in clinical cultures decreased during COVID-19 but not the rate in surveillance cultures. Further studies are warranted to study the impact of COVID-19 on CREs.

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Type
Multidrug-Resistant (MDR) Organisms
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America