Clinical characteristics and risk factors for the isolation of multi-drug-resistant Gram-negative bacteria from critically ill patients with COVID-19

Abstract

Background We investigated the clinical characteristics and risk factors for the isolation of multidrug resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. Methods We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls). Results Seventy-eight cases were identified (4.5 per 1,000 ICU days, 95% confidence interval [CI] 3.6–5.7). Out of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agent within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P = 0.19). Mechanical ventilation days (adjusted odds ratio [aOR] 1.062, 95% CI 1.012 to 1.114; P 0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (aOR 2.426, 95% CI 0.833 to 7.069; P = 0.104). Conclusion In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimising the use of invasive devices, and to remove them as soon as their presence is no longer necessary.

Carbapenem-Resistant Klebsiella pneumoniae Infections in ICU COVID-19 Patients—A Scoping Review

“…These findings may raise concerns of overuse of antibiotic therapy and a subsequent contribution to the development of increased bacterial resistance [ 19 , 43 ]. Therefore, further research on co-infections is needed to provide rational antibiotic therapy in the era of the SARS-CoV-2 pandemic [ 48 , 49 ]. It is also important to remember that altered, difficult working conditions and fatigue can cause burnout among HCWs, thereby decreasing commitment to their work and adherence to infection prevention and control.…”

Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study

“…Understanding the epidemiology and risk factors of MDROs in COVID-19 patients is very important for establishing strategies to treat COVID-19 and prevent infection by MDROs. Although, several studies reported MDRO isolation and antimicrobial stewardship challenges in patients in COVID-19 [12][13][14] , only few studies have dealt with risk factors of MDRO isolation in patients with COVID-19 15 . Therefore, the aim of this study was to evaluate incidences of and risk factors for isolation of MDROs in COVID-19 patients.…”

The Complexity of Co-Infections in the Era of COVID-19

“…The greater the presence of patient co-morbidities, the more frequent the finding of co-incident infections [125,135]. Gram-negative bacillus infections are associated with increased hospital stay and severe COVID-19 [118,140,[157][158][159][160]. They more often arise either in the respiratory tract, with intravenous access devices, or with genitourinary foci [145,155,156,158,160].…”

“…Gram-negative bacillus infections are associated with increased hospital stay and severe COVID-19 [118,140,[157][158][159][160]. They more often arise either in the respiratory tract, with intravenous access devices, or with genitourinary foci [145,155,156,158,160]. Bacteremias tend to be less common but are more likely to be seen with intensive care patients [77,145,156,159,161].…”

“…Cusumano et al [163] particularly find that Staphylococcus aureus bacteremia may be an important predictor of worse outcome. There is an increasing antibiotic resistance profile with co-infection [122,123,127,135,137,140,142,144,146,157,159,160,163,164]. For example, some American centers have been particularly inundated with multi-resistant coliforms [135,157].…”