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.