Antimicrobial Resistance Trends in COVID-19 Patients with Hospital Infection in Intensive Care: A Retrospective Study in Central Italy, 2020-2022.

Antimicrobial resistance (AMR) was exacerbated by COVID-19 pandemic. This study describes prevalence and trends of AMR in patients with diagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted during 2020-2022 to the intensive care unit (ICU) in Molise region, central Italy. A retrospective study was conducted, including patients aged ≥ 18 years with at least one positive bacterial or fungal culture during ICU stay. Data were related to patient demographics, ICU outcomes, healthcare-associated infections, and antimicrobial susceptibility profiles. During the 2020-2022 period, 103 ICU admissions met the inclusion criteria, yielding 268 isolations, of which 157 underwent antimicrobial susceptibility testing. Apart from high proportion of Candida albicans, Gram-negative bacteria predominated, with Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii among the most frequent. Resistance to beta-lactams and carbapenems was consistently high, while it ranged from 53.8% to 66.7% to fluoroquinolones and remained above 50% to aminoglycosides. Tetracycline resistance showed significant year-to-year variation, increasing in 2022 compared with both 2020 and 2021. AMR rates in COVID-19 patients in ICU were persistently high throughout the pandemic, with critical resistance levels in Gram-negatives, underlining the need to reinforce infection prevention and control measures and antimicrobial stewardship programs and align prescribing practices with World Health Organization AWaRe recommendations, even during public health emergencies.