Relationship between COVID-19 and ICU-Acquired Bloodstream Infections Related to Multidrug-Resistant Bacteria

Abstract

A bloodstream infection (BSI) is a severe ICU-acquired infection. A growing proportion is caused by multidrug-resistant bacteria (MDRB). COVID-19 was reported to be associated with a high rate of secondary infections. However, there is a lack of data on the relationship between COVID-19 and the incidence of MDRB ICU-acquired BSI. The aim of this study was to evaluate the relationship between COVID-19 and ICU-acquired BSI related to MDRB. This retrospective study was conducted in a single-center ICU during a one-year period. All adult patients admitted for more than 48 h were included. The cumulative incidence of ICU-acquired BSI related to MDRB was estimated using the Kalbfleisch and Prentice method. The association of COVID-19 status with the risk of ICU-acquired BSI related to MDRB was assessed using cause-specific Cox’s proportional hazard model. Among the 1320 patients included in the analysis, 497 (37.65%) had COVID-19. ICU-acquired BSI related to MDRB occurred in 50 patients (36 COVID patients (7%) and 14 non-COVID patients (1.6%)). Extended-spectrum beta-lactamase Enterobacteriacae (46%) and carbapenem-resistant Acinetobacter baumannii (30%) were the most commonly isolated MDRB. COVID-19 was significantly associated with a higher risk of MDRB ICU-acquired BSI (adjusted cHR 2.65 (1.25 to 5.59) for the whole study period). However, this relationship was only significant for the period starting at day 15 after ICU admission. ICU-acquired BSI related to MDRB was significantly associated with ICU mortality (HR (95%CI) 1.73 (1–3)), although COVID-19 had no significant impact on this association (p het 0.94). COVID-19 is significantly associated with an increased risk of ICU-acquired BSI related to MDRB, mainly during the period starting at day 15 after ICU admission.

ICU-Acquired Colonization and Infection Related to Multidrug-Resistant Bacteria in COVID-19 Patients: A Narrative Review

“…Regarding the incidence of BSI related to MDR bacteria, a retrospective monocentric study on 497 COVID-19 patients and 823 controls reported that COVID-19 patients had a higher incidence of BSI related to MDR bacteria [ 38 ] (adjusted cause-specific HR (cHR) 2.65, 95% CI 1.25–5.59, in line with the COVID-BMR study [ 37 ]). Similarly, a retrospective international study in 53 ICUs found an increased incidence of hospital-acquired BSI related to difficult-to-treat Gram-negative bacteria in COVID-19 ( n = 252) vs. controls ( n = 577; 19.4% vs. 13%, p = 0.017) [ 29 ].…”

“…As presented in Table 1 , 24 studies providing estimates of the association between COVID-19 status and ICU-acquired infection/colonization with resistant bacteria fulfilled our inclusion criteria [ 2 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ].…”

“…Interestingly, similar findings were obtained in the study by Buetti et al (looking at BSI related to DTR Gram-negative bacteria) [ 29 ] and in the study by Cogliati Dezza et al (looking at BSI related to MDR Gram-negative bacteria) [ 27 ]. In the study by Piantoni et al, we found that ICU-acquired MDR BSI was associated with increased mortality in the overall cohort (adjusted HR 1.73, 95% CI 1.0–3.0), with no effect of COVID-19 status on this association [ 38 ]. Both in COVID-BMR [ 37 ] and in the study by Piantoni et al [ 38 ], there was no impact of the occurrence of ICU-acquired colonization and/or infection with MDR bacteria on ICU LOS and on the duration of IMV in the overall cohort, in COVID-19 patients, and in controls.…”

“…In the study by Piantoni et al, we found that ICU-acquired MDR BSI was associated with increased mortality in the overall cohort (adjusted HR 1.73, 95% CI 1.0–3.0), with no effect of COVID-19 status on this association [ 38 ]. Both in COVID-BMR [ 37 ] and in the study by Piantoni et al [ 38 ], there was no impact of the occurrence of ICU-acquired colonization and/or infection with MDR bacteria on ICU LOS and on the duration of IMV in the overall cohort, in COVID-19 patients, and in controls.…”