Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients’ Outcome

Abstract

Background: Bloodstream infections (BSI) caused by highly resistant pathogens in non-ICU COVID-19 departments pose important challenges. Methods: We performed a comparative analysis of incidence and microbial epidemiology of BSI in COVID-19 vs. non-COVID-19, non-ICU departments between 1 September 2020-31 October 2021. Risk factors for BSI and its impact on outcome were evaluated by a case-control study which included COVID-19 patients with/without BSI. Results: Forty out of 1985 COVID-19 patients developed BSI. The mean monthly incidence/100 admissions was 2.015 in COVID-19 and 1.742 in non-COVID-19 departments. Enterococcus and Candida isolates predominated in the COVID-19 group (p < 0.001 and p = 0.018, respectively). All Acinetobacter baumannii isolates were carbapenem-resistant (CR). In the COVID-19 group, 33.3% of Klebsiella pneumoniae was CR, 50% of Escherichia coli produced ESBL and 19% of Enterococcus spp. were VRE vs. 74.5%, 26.1% and 8.8% in the non-COVID-19 group, respectively. BSI was associated with prior hospitalization (p = 0.003), >2 comorbidities (p < 0.001), central venous catheter (p = 0.015), severe SARS-CoV-2 pneumonia and lack of COVID-19 vaccination (p < 0.001). In the multivariate regression model also including age and multiple comorbidities, only BSI was significantly associated with adverse in-hospital outcome [OR (CI95%): 21.47 (3.86–119.21), p < 0.001]. Conclusions: BSI complicates unvaccinated patients with severe SARS-CoV-2 pneumonia and increases mortality. BSI pathogens and resistance profiles differ among COVID-19/non-COVID-19 departments, suggesting various routes of pathogen acquisition.

The significant role of Carbapenems-resistant Acinetobacter Baumannii in mortality rate of patients with COVID-19

“…In line with our results, a recently published study also reported that all of their A. baumannii isolates collected from COVID-19 patients were CR [ 7 ]. Additionally, Sathyakamala et al reported Acinetobacter species as a bacterial pathogen with maximum antimicrobial resistance among COVID-19 and non-COVID-19 patients admitted to the ICU [ 8 ].…”

“…Additionally, MDR A. baumannii infections were reported as one of the most prevalent bacterial co-infection in patients with COVID-19 [ 7 , 8 ]. The use of corticosteroids and anti-IL6-directed therapies in COVID-19-positive patients suppresses the immune system and causes a high incidence of microbial co-infections in these patients.…”

The significant role of Carbapenems-resistant Acinetobacter Baumannii in mortality rate of patients with COVID-19

“…To this end, the hospital A reported the most infected and dead patients. Therefore, CR- A. baumannii outbreaks in this hospital could be partly associated with shortages in personnel, personal protective equipment, and dedicated medical equipment, which had affected the conventional infection prevention and control practices [ 7 ]. To this end, the hands of healthcare workers can act as vehicles for transmission either from a colonized patient to other patients or contaminated surfaces to patients.…”

COVID-19 pandemic The need to treat a large number of patients with acute respiratory failure

“…MRSA je proteklih godina bila suprimirana ponovo se pojavila kao česti uzročnik bolničkih infekcija, a porastao je broj infekcija uzro kovanih Acinetobacter sp. i MR K. pneumoniae 9 . Odr žavanje higijene ruku postalo je glavni problem unu tar pretrpanih bolničkih kapaciteta i mjera osobne zaštite 10 .…”