Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

Abstract

IntroductionIn hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance.MethodsHospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses.ResultsThe study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018).ConclusionsIn patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.

The Hidden Cost of COVID-19: Focus on Antimicrobial Resistance in Bloodstream Infections

“…An investigation conducted on HA-BSI in patients deceased with COVID-19 in Italy, identified A. baumannii as one of the most frequently isolated pathogens, mainly in ICU, with a 100% of carbapenem resistance profile [ 64 ]. Similar results were confirmed in a retrospective observational study conducted in Greece, showing CR-Ab as the principal cause of Gram-negative BSI [ 65 ].…”

Corticosteroid Dosing Level, Incidence and Profile of Bacterial Blood Stream Infections in Hospitalized COVID-19 Patients

“…Of those positive blood culture isolates, a higher occurrence of Acinetobacter baumannii , CoNS , Staphylococcus aureus and Enterococcus species was significantly associated with the use of higher corticosteroid doses ( p < 0.05 for all analyses), while the occurrence of Klebsiella pneumoniae isolates was comparable. Acinetobacter baumannii was reported in earlier studies as the most frequent Gram-negative BSI in COVID-19 patients [ 32 , 44 ]. Our findings are very similar to those of Frattari et al, who found that not only was Acinetobacter baumannii the most frequent cause of bacteremia, while preceded colonization was documented in only 7% of cases, but that bacteremia was implied to be hospital-acquired [ 36 ].…”

“…Our findings are very similar to those of Frattari et al, who found that not only was Acinetobacter baumannii the most frequent cause of bacteremia, while preceded colonization was documented in only 7% of cases, but that bacteremia was implied to be hospital-acquired [ 36 ]. Moreover, the use of corticosteroids was found to be associated with hospital-acquired Acinetobacter baumannii bacteremia, resulting in poorer outcomes, while early administration was associated with increased bacterial resistance [ 44 , 45 ]. These, along with previous findings of an association between high-dose steroids and Acinetobacter bacteremia [ 46 ], support our hypothesis.…”

“…Increases in Enterococcus BSIs were frequently reported in COVID-19 patients, and more frequently than in the non-COVID population [ 6 , 7 , 12 , 32 , 43 , 44 ]. Genome sequencing performed in one study advocates against nosocomial transmission [ 43 ].…”

Secondary Infection Surveillance with Metagenomic Next-Generation Sequencing in COVID-19 Patients: A Cross-Sectional Study

“… 8 Such secondary infections, especially secondary invasive fungal infection (IFIs) and bloodstream infections, increased morbidity and mortality of hospitalized COVID-19 patients. 5 , 9 Therefore, the rapid comprehensive identification of the pathogens responsible for the development of secondary infections in COVID-19 patients is essential to implement individually tailored antibiotic therapy, improve antimicrobial stewardship and help prevent emergence and transmission of multi-drug-resistant (MDR) organisms.…”