Predictors of carbapenem-resistant Enterobacteriaceae (CRE) strains in patients with COVID-19 in the ICU ward: a retrospective case–control study

Abstract

Objective To identify carbapenem-resistant Enterobacteriaceae (CRE) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) and to determine whether they had different risk factors for the acquisition of CRE than patients without COVID-19. Methods This retrospective single-centre, case–control study enrolled patients with and without COVID-19. The demographic, clinical, infection, colonization and mortality data were compared between the two groups. Results A total of 38 patients with COVID-19 and 26 patients without COVID-19 were enrolled. The majority of isolates detected in COVID-19 patients were Klebsiella spp. Leukopenia at admission (odds ratio [OR] 4.70; 95% confidence interval [CI] 1.37, 16.10), invasive mechanical ventilation (OR 5.74; 95% CI 1.07, 30.63), carbapenem treatment (OR 5.09; 95% CI 1.21, 21.27) and corticosteroid treatment (OR 7.06; 95% CI 1.53, 32.39) were independent risk factors for CRE acquisition in COVID-19 patients. Intensive care unit (ICU) mortality was significantly higher in COVID-19 patients compared with patients without COVID-19 (OR 20.62; 95% CI 5.50, 77.23). Length of ICU stay increased the risk of death in patients with COVID-19 (subdistribution hazard ratio 3.81; 95% CI 1.33, 10.92). Conclusion CRE strains were more common in patients with COVID-19 and they had different risks for CRE compared with patients without COVID-19.

Role of Probiotics in Preventing Carbapenem-Resistant Enterobacteriaceae Colonization in the Intensive Care Unit: Risk Factors and Microbiome Analysis Study

“…Longer lengths of ICU stay, carbapenem treatment, corticosteroid treatment, and invasive mechanical ventilation were frequently applied to COVID-19 ICU patients, increasing their susceptibility to CRE acquisition [17]. Additionally, elderly patients admitted to the COVID ICU were likely to be initially undetectable CRE carriers from long-term care facilities in the Korean medical environment [18]. Infection prevention management in the COVID ICU was also challenging due to the wearing of protective clothing and the risk of COVID-19 infection.…”

“…Probiotics exert their effects by producing short-chain fatty acids from metabolic precursors, leading to similar downstream effects, such as immune modulation and increased mucosal barrier function [18]. Moreover, they may have the added effect of producing their own antimicrobial compounds, physically occupying the epithelial niche, and limiting the ability of other pathogens to colonize the enteric microbiome; specifically, their main effect on the clearance or decolonization of MDRO is dysbiosis [7], which possesses the primary mechanism of CRE acquisition and expansion.…”

"Multidrug-Resistant Bacteria Related to Covid-19 Infection: A Minireview"

“…The study by Thomas et al reported an emerging in carbapenemase-resistant Enterobacteriaceae isolates by 42.8% in Brazil, and an increase from 73.6% to 88.4% in the total number of carbapenemase genes detected. The emergence of new genes that have not been identified yet has been reported in Chile, Dominica and Belize, while Peru, Ecuador, Venezuela and Costa Rica have reported the emergence of new combinations of carbapenemase [53][54][55][56][57][58].…”