EOC 10 - The Impact of COVID-19 on the Incidence of Carbapenemase Producing Organisms in Acute Care Inpatients in British Columbia, Canada

Background: Carbapenemase Producing Organisms (CPO) are associated with increased patient morbidity and mortality. The objectives of this study were to describe the epidemiology of CPOs, associated outcomes and to determine the impact of the COVID-19 pandemic, declared in 2020, on the incidence of CPOs within a health authority in British Columbia.

Methods: This cross-sectional study included acute care inpatients who tested positive for CPO from clinical or surveillance specimens between January 1, 2018 and December 31, 2023. Infection Prevention and Control professionals collected data using a standardized tool on age, sex, previous healthcare, known CPO contacts, and international travel. Annual incidence rates, Standardized Infection Ratios (SIR), and 95% Confidence Interval (CI) were estimated using 2018 as a baseline. Analyses were conducted using Stata/SE17 and OpenEpi version 3.01.

Results: This study identified 584 CPO genes from 520 patients. The median age was 56 years (range < 1 to 99 years), 56% were males, and 14% were infections. The all-cause 30-day mortality for infections was 25%. The New Delhi metallo-beta-lactamase (NDM) gene accounted for 65% of genes. Foreign travel was reported in 59% of cases. Approximately 351 (68%) were identified within 72 hours of admission, with 16% reporting no international travel or foreign healthcare (incidental cases). Compared to 2018, decreases in the overall number of CPO cases were observed in 2020 (SIR 0.79, 95% CI 0.64-0.97) and 2021 (SIR 0.45, 95% CI 0.34-0.58).
Annual increases in incidental cases were observed, with 2022 having a SIR of 3.60 (95% CI 2.74-4.75).

Conclusions: CPO incidence decreased significantly in 2020 and 2021, likely due to global travel restrictions. However, there is an increasing trend in the annual number of incidental CPO cases, suggesting local acquisition. These findings suggest a need for expanding existing CPO screening criteria and they reinforce the need for strict CPO prevention strategies in hospitals.