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.
Multisystem Inflammatory Syndrome is a rare and novel clinical presentation described during the evolving COVID‐19 pandemic. The condition is usually presenting as a sepsis‐like syndrome leading to secondary multi‐organ dysfunction post–COVID‐19 infection. Although the syndrome has been mainly described in children, rare adults' form has been similarly described. We are describing a 37‐year‐old female patient presented with fever and neck pain after 1 month of a mild SARS‐CoV‐2 infection course and 10 days post her second COVID‐19 vaccine. Examination demonstrated fever, hypotension, and hypoxemia, in addition to multiple tender cervical lymph nodes. Initial laboratory workup showed evidence of significant inflammation with raised markers, including C‐reactive protein, ferritin, and interleukin‐6. Extensive evaluation to rule out active infection was done, and all return negative, including repeat SARS‐CoV‐2 test. Furthermore, cardiac evaluation showed moderately reduced systolic ventricular function. Despite all negative test and supportive measures, the patient continued to deteriorate requiring critical care admission for ionotropic support, non‐invasive ventilation in addition to presumptive broad‐spectrum antimicrobial management. There was no significant improvement with supportive care until the presentation of multisystem involvement on in the context of a recent history of COVID 19 and negative infective screen was raised. The diagnosis of multisystem inflammatory syndrome‐adult form (MIS‐A) was embraced, and the patient was commenced on methylprednisolone leading to a dramatic resolution of symptoms both clinically and biochemically with stabilization of vital functions allowing for safe outcomes.
Chryseobacterium gleum
is a Gram-negative aerobic bacillus. It commonly colonizes mechanical devices, causing device-associated infections like central line–associated bloodstream infection and ventilator-associated pneumonia. We describe two cases of
C. gleum
bacteraemia in patients admitted to our intensive care unit in Qatar, one of which resulted in death. Long hospital stays and indwelling devices are risk factors for
C. gleum
bacteraemia. Because
C. gleum
is inherently resistant to β-lactam antibiotics, rapid identification and antimicrobial susceptibility testing are essential for guiding therapy.
Highlights
Hydatidosis is an endemic infection and can involve a variety of organ systems.
The mediastinum is one of the rarest locations of hydatidosis.
It can occur primarily or secondarily to intrathoracic and intraabdominal Echinococcus.
Surgical treatment remains very crucial in the management of these cases.
The exact mechanism by which primary mediastinal hydatidosis occurs remains a debatable subject.
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