Klebsiella pneumoniae infections in COVID-19 patients: a 2-month retrospective analysis in an Italian hospital

Arcari, Gabriele; Raponi, Giammarco; Sacco, Federica; Bibbolino, Giulia; Lella, Federica Maria Di; Alessandri, Francesco; Coletti, Monica; Trancassini, Maria; Deales, Alberto; Pugliese, Francesco; Antonelli, Guido; Carattoli, Alessandra

doi:10.1016/j.ijantimicag.2020.106245

Cited by 52 publications

(53 citation statements)

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“…With regard to the isolates causing respiratory superinfections, Acinetobacter baumannii was more frequently observed in FLU patients, whereas Pseudomonas aeruginosa was more frequent in COVID-19 and OXA-48 carbapenemase-producing Klebsiella pneumoniae was found only in COVID-19 subjects. The latter finding was confirmed by the rate of OXA-48 rectal colonization in COVID-19 patients, probably representing a small outbreak within the ICU, which was further limited with appropriate infection control measures [ 34 ]. The rate of bloodstream infections was similar, with 8 (42.1%) and 23 (42%) events in FLU and COVID-19 subjects, respectively ( p = 0.589).…”

Section: Resultsmentioning

confidence: 96%

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

et al. 2021

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Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

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Section: Resultsmentioning

confidence: 96%

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

et al. 2021

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“…Positive cultures for carbapenemase-producing K. pneumoniae were found in 14 patients (22%). Seven patients developed co-infection that was confirmed in 5 bronchoalveolar lavages and 2 blood cultures [ 37 ]. In a Magnasco, L. et al study, 2 ICU patients were colonized with CRKP.…”

Section: Resultsmentioning

confidence: 99%

“…García-Menioño et al (Spain), who identified the occurrence of the OXA-48 gene among their patients, highlighted the fact that, so far, none of the patients had been previously colonized by Enterobacteriaceae producing this gene [ 35 ]. Furthermore, Arcari et al (Italy) pointed out that while the occurrence of KPC strains has been described in their country, the OXY-48 gene has rarely been reported [ 37 ]. Ramadan et al, who in their study undertook the characterization of patients with COVID-19 from Upper Egypt, noted that no co-infections were observed in patients in the mild severity group.…”

Section: Discussionmentioning

confidence: 99%

“…In some presented studies, the discrimination between colonization and infection was not clear enough [ 31 , 34 , 38 ]. Although the use of broad spectrum antibiotics is the major drive for MDR pathogens, four (out of ten), studies did not mention their use in COVID 19 patients prior to MDR organism infection [ 31 , 33 , 37 , 38 ]. Studies from Italy are overpresented.…”

Section: A Limitation Of Scoping Reviewmentioning

confidence: 99%

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

Mędrzycka‐Dąbrowska

Lange²,

Zorena

et al. 2021

JCM

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Introduction: The spread of multidrug-resistant pathogens is a serious problem and challenge for the whole medical community. Carbapenem-resistant Klebsiella Pneumoniae (CRKP) infections in immunocompromised patients have a severe course and may be fatal. Increasingly, these bacteria are exhibiting resistance to carbapenem antibiotics, which have been used as so-called drugs of last resort. The emergence of the new coronavirus and the pandemic that it has caused require changes to protect against the spread of the new SARS-CoV-2. These changes paradoxically may contribute to the spread of other infections. Methods: PubMed, Cochrane Library databases were searched using relevant keywords. A literature review of carbapenem-resistant Klebsiella Pneumoniae infection in patients hospitalized for COVID-19 was conducted according to PRISMA recommendations. A written review protocol was not prepared. Results: 1016 studies in scientific databases were searched. After rejecting duplicate studies, 964 results were obtained. Inclusion and exclusion criteria were then applied, and studies were qualitatively analyzed. Finally, 11 studies were included in the review. The results of infected patients were from six countries. The prevalence of CRKP in Covid-19 patients ranged from 0.35–53%. The majority of CRKP infected patients were male (85%), with a mean age of 61 years. Among isolates, the predominant genes were KPC, OXY-48, CTX-M, TEM, NDM and SHV. Conclusion: The results presented in our review indicate the necessity of paying attention to carbapenem-resistant Klebsiella Pneumoniae infections in patients with COVID-19. In order to prevent the increase of bacterial resistance, rational antibiotic therapy should be used, as well as continuous control and surveillance of hospital infections caused by multidrug-resistant organisms.

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“…The differential diagnosis of bacterial and viral meningitis remains an important and unsolved clinical problem, especially in the initial hours of hospitalization, before receiving lumbal puncture results. Classical clinical diagnostic signs have limited value in establishing the diagnosis of meningitis [6] [7] [8].…”

Section: Introductionmentioning

confidence: 99%

Laboratory Diagnosis of Bacterial Meningitis in a Patient with COVID-19

Gencheva-Angelova¹

2021

JBM

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Against the background of a COVID-19 infection, the overlap of bacterial coinfection is associated with an increased risk of poor treatment outcomes. A 76-year-old man was treated for ischemic stroke in the period of one week. During his hospital stay, he showed symptoms of a viral infection, due to which a PCR sample was taken for SARS-CoV-2. The test result was positive. Meningoencephalitis is suspected on the basis of the clinical symptoms shown and the initial blood test. K. pneumonia was detected by a cerebrospinal fluid (CSF) microbiological examination. The risk of bacterial coinfection with COVID-19 remains unclear. Timely and rapid diagnosis and treatment of bacterial meningitis, in the context of a proven COVID-19 infection, require a variety of biological tests and a multidisciplinary approach. In the early stages of acute bacterial and viral meningitis, the signs and symptoms are often nonspecific and it is not always possible to make a differential diagnosis. Laboratory tests, characterizing COVID-19, should determine the type, prognosis, and outcome of a bacterial coinfection. Refining the laboratory diagnosis of a bacterial infection with COVID-19 is a new challenge for doctors.

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Klebsiella pneumoniae infections in COVID-19 patients: a 2-month retrospective analysis in an Italian hospital

Cited by 52 publications

References 5 publications

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

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

Laboratory Diagnosis of Bacterial Meningitis in a Patient with COVID-19

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