Increase in Healthcare-Associated Infections: Is COVID-19 Responsible? A Narrative Review

Abstract

During the COVID-19 pandemic, healthcare-associated infections (HAIs) showed a significant increase, exacerbated by the prevalence of multidrug-resistant (MDR) organisms. Antibiotic overuse and infection control practices influenced HAI incidence rates, alongside the rising prevalence of resistant pathogens such as methicillin-resistant Staphylococcus aureus. Antibiotic-resistant pathogens causing healthcare-associated infections in COVID-19 patients include—in addition to methicillin-resistant Staphylococcus aureus—metallo-β-lactamase-producing carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase-producing Klebsiella pneumoniae, and vancomycin-resistant enterococci. COVID-19 impacted bacterial healthcare-associated infections in various ways, with an increase in the incidence of metallo-β-lactamase-producing, carbapenem-resistant organisms—a trend already noted prior to the pandemic. Furthermore, the pandemic laid the groundwork for future challenges in HAI management, highlighting the need for rigorous infection prevention and control protocols. Poorer outcomes were observed in hospitalized COVID-19 patients with antibiotic-resistant infections. Although increased infection prevention and control (IPC) measures led to a reduction in certain site-specific hospital-acquired infections, in other contexts, COVID-19 was associated with an increased incidence of bacterial hospital-acquired infections. Further research is needed to determine the cost–benefit ratio of maintaining COVID-19-related infection prevention and control protocols beyond the pandemic in order to reduce the impact of hospital-acquired infections. Furthermore, it is necessary to assess the long-term impact of the high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic.