Increased Incidence and Risk Factors of Infections by Extended-Spectrum β-Lactamase-Producing Enterobacterales During the COVID-19 Pandemic: A Retrospective Case-Control Study

Yuhui Geng,1,* Furong Li,2,* Chen Chen,3 Zhuo Liu,1 Xiaojuan Ma,1 Xinya Su,1 Hua Meng,1 Wenwen Lu,1 Xingtian Wang,1 Dongfeng Pan,4 Peifeng Liang5 1School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; 2Department of Clinical Laboratory, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China; 3Department of Public Health, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China; 4Department of Emergency Medicine, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China; 5Department of Medical Records and Statistics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Peifeng Liang, Department of Medical Records and Statistics, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, People’s Republic of China, Tel +86 951 13895085519, Email doctor_pf@126.comPurpose: To investigate changes in the incidence of infections by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) and analyzed whether there was an association between endogenous changes in the organism due to COVID-19 infection and the infections by ESBL-E.Patients and Methods: The study was a single-center retrospective case-control design. A total of 107 patients infected by ESBL-E during the COVID-19 pandemic were selected as the case group, while 214 uninfected patients selected by 1:2 propensity score matching (PSM) acted as the control group. Univariate analysis, LASSO logistic regression, and multivariate logistic regression were used to determine the risk factors for ESBL-E infection. An interrupted time series was used to analyze the changes in the incidence of ESBL-E infections in hospitalized patients during the COVID-19 pandemic.Results: The incidence of infection with ESBL-E showed a significant increase during COVID-19 (3.42 vs 4.92 per 1000 patients, p = 0.003). The incidence of ESBL-E infections increased at an average rate of 0.45 per 1000 patients per week compared to the pre-pandemic period (p = 0.022). Multivariate logistic regression analysis showed that a length of hospitalization ≥ 15 days (OR: 2.98 (1.07– 8.28), chronic kidney disease (OR: 4.25 (1.32– 13.70), white blood cell (WBC) > 9.5× 10^9/L (OR: 3.04 (1.54– 6.01), use of hormonal drugs (OR: 2.38 (1.04– 5.43), antibacterial drug use 1 type (OR: 5.38 (2.04– 14.21), antibacterial drug use 2 types (OR: 23.05 (6.71– 79.25) and antibacterial drug use ≥ 3 types (OR: 88.35 (8.55– 912.63) were independent risk factors for infection with ESBL-E, while chronic obstructive pulmonary disease (COPD) was a protective factor (OR: 0.14 (0.03– 0.66). COVID-19 was not an independent risk factor for infection by ESBL-E.Conclusion: During the COVID-19 pandemic, the incidence of infections by ESBL-E increased significantly. Increased exposure to traditional risk factors were the main reasons, however, COVID-19 was not an independent risk factor for ESBL-E infection.Keywords: β-lactamases, COVID-19, risk factor, antibacterial drugs, case-control study, LASSO