Multidrug-resistant Organisms Among Patients in COVID-19 Wards Compared to Non-COVID-19 Wards in Indonesian Hospitals

AIM: To determine the prevalence of multidrug-resistant organisms (MDROs) among patients in COVID-19 wards compared to non-COVID-19 wards in two Indonesian hospitals. BACKGROUND: The effect of the COVID-19 pandemic on the emergence and spread of MDROs is largely unknown, especially in limited-resource settings. METHODS: A prospective, observational cohort study was conducted in both COVID-19 and non-COVID-19 wards of Ngudi Waluyo Hospital, Wlingi, Blitar (NWH, secondary care) and Dr. Saiful Anwar Hospital, Malang (SAH, tertiary care), Indonesia. Adult patients admitted to these wards were included from March 2022 to March 2023, with their clinical samples taken for routine care (blood, lower respiratory tract specimens, pus, and urine). MDROs were identified using the Vitek2 system. RESULTS: A total of 3,698 patients were included: SAH with 2,921 patients (COVID-19: 1,339; non-COVID-19: 1,582) and NWH with 777 patients (COVID-19: 320; non-COVID-19: 457). Overall, MDRO prevalence among patients was higher in SAH (17.7%) than in NWH (3.9%) (p<0.001). Patients with MDROs were more frequently detected in non-COVID-19 wards compared to COVID-19 wards in both hospitals (SAH: 19.8%/15.3%, p=0.001; NWH: 5%/2.2%, p=0.030). In SAH, ESBL-producing-Escherichia coli and -Klebsiella pneumoniae were the most prevalent MDROs among COVID-19 patients (10.0%), while carbapenem-resistant-Acinetobacter baumannii was predominant among non-COVID-19 patients (9.7%). In NWH, ESBL-producing-Escherichia coli and -Klebsiella pneumoniae were the most common MDROs in both COVID-19 (1.9%) and non-COVID-19 patients (3.5%). CONCLUSIONS: MDRO prevalence was higher among non-COVID-19 patients compared to COVID-19 patients. Further investigation is needed to analyze MDRO transmission in both settings.