{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:05:29Z","timestamp":1789988729847,"version":"4.0.1"},"reference-count":77,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:00:00Z","timestamp":1789776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>The COVID-19 pandemic redirected infection control and antimicrobial stewardship towards SARS-CoV-2, potentially increasing multidrug-resistant (MDR) bloodstream infections (BSIs). We compared MDR BSI epidemiology and outcomes in a non-COVID intensive care unit (ICU) before and after the pandemic. The MATURATE ICU study retrospectively included adults with MDR BSIs admitted to a non-COVID ICU during the pre-COVID-19 (1 January 2017\u20131 January 2020) and post-COVID-19 (1 January 2022\u20131 January 2025) eras. Clinical, microbiological and outcome data were compared. Survival analyses and multivariable logistic regression identified predictors of ICU mortality. Overall, 146 patients were included (74 pre-COVID-19 and 72 post-COVID-19). Pre-COVID-19 patients were older and had higher comorbidity burden and severity indices (all p \u2264 0.023). ICU stay after the first positive blood culture was longer in the post-COVID-19 period (p = 0.003). New organ dysfunction, acute kidney injury, and septic shock were more frequent pre-COVID-19, whereas cardiovascular events were more frequent post-COVID-19. ICU mortality was higher pre-COVID-19 (p &lt; 0.001). Competing-risk analysis, treating ICU discharge alive as a competing event, demonstrated a significantly lower cumulative incidence of ICU death in the post-COVID-19 era (adjusted sHR 0.20, 95% CI 0.11\u20130.35; p &lt; 0.001). In multivariable analysis, post-COVID-19 era independently predicted lower 28-day ICU mortality (adjusted OR = 0.11, 95% CI 0.04\u20130.28, p &lt; 0.001), whereas higher CCI (adjusted OR = 1.31, 95% CI 1.04\u20131.69, p = 0.027) and SOFA (adjusted OR = 1.22, 95% CI 1.07\u20131.40, p = 0.003) independently predicted increased mortality. Despite the persistently high burden of antimicrobial resistance, improved post-COVID-19 survival suggests that, advances in ICU care and healthcare system recovery may have contributed to better outcomes.<\/jats:p>","DOI":"10.3390\/microorganisms14092098","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T10:25:43Z","timestamp":1789986343000},"page":"2098","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidrug-Resistant Bloodstream Infections Before and After COVID-19: A Temporal Assessment of Outcomes and Resistance Across Two Eras in a Non-COVID Intensive Care Unit\u2014The MATURATE ICU Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Sotiria","family":"Kefala","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Foteini","family":"Fligou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, University General Hospital of Patras, 26504 Rio, Greece"},{"name":"Faculty of Medicine, University of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Ioannis","family":"Chandroulis","sequence":"additional","affiliation":[{"name":"School of Science and Technology, Hellenic Open University, 26335 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Marina","family":"Amerali","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0268-8854","authenticated-orcid":false,"given":"Stamatia","family":"Tsoupra","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Eirini","family":"Zarkadi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Eleni","family":"Polyzou","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Panagiota","family":"Pnevmatikou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4348-6077","authenticated-orcid":false,"given":"Fevronia","family":"Kolonitsiou","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Patras, 26504 Rio, Greece"},{"name":"Department of Microbiology, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4289-9494","authenticated-orcid":false,"given":"Karolina","family":"Akinosoglou","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Patras, 26504 Rio, Greece"},{"name":"School of Science and Technology, Hellenic Open University, 26335 Patras, Greece"},{"name":"Department of Internal Medicine, University General Hospital of Patras, 26504 Rio, Greece"},{"name":"Division of Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: A systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Bari\u0161i\u0107, V., Kova\u010devi\u0107, T., Travar, M., Goli\u0107 Jeli\u0107, A., Kova\u010devi\u0107, P., Vu\u010di\u0107evi\u0107, K., 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