Healthcare-Associated Infections on the ICU in 21 Brazilian Hospitals During the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and it might have affected healthcare-associated infections (HAI) prevention strategies. This study aims to evaluate the impact of the COVID-19 pandemic on HAI incidence in Brazilian ICUs. Methods: This ecological study compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (pre-pandemic period). We collected data from 21 hospitals from the three most populated Brazilian regions. The difference in microbiologically confirmed central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density, and the proportion of organisms that caused HAI between the pandemic and the pre-pandemic periods were compared in a pairwise analysis using the Wilcoxon signed rank sum test.  Findings: We observed a significant increase in CLABSI incidence during the pandemic (2.81 [1.35 - 6.89] vs. 1.60 [0.44 - 4.20], p = 0.002). Overall, there was no difference in VAP incidence between the two periods, but there was an increase in VAP incidence in private hospitals during the pandemic (3.65 [1.42 - 6.57] vs. 2.54 [0 - 3.98], p = 0.033). In addition, there was a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and candida species during the pandemic. Interpretation: There was an increase in CLABSI incidence in Brazilian hospitals during the COVID-19 pandemic. Additionally, we observed an increase in the proportion of CLABSI caused by E. faecalis and candida species in this period.  Funding: None. Declaration of Interests: None. Ethics Approval Statement: The study protocol 77243517.8 was approved by the ethics committee of each participating hospital.