Acinetobacter baumannii Isolates from COVID-19 Patients in a Hospital Intensive Care Unit: Molecular Typing and Risk Factors

Abstract

Infections caused by Acinetobacter baumannii represent a major concern for intensive care unit (ICU) patients. However, the epidemiology of these infections among COVID-19 patients has not been fully explored. The aims of this study were (i) to characterize the clonal spread of A. baumannii among COVID-19 patients admitted to the ICU of the Umberto I hospital of Rome during the first year of the pandemic and (ii) to identify risk factors for its acquisition. Isolates were analysed by pulsed-field gel electrophoresis, and a multivariable regression model was constructed. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. Overall, 193 patients were included, and 102 strains were analysed. All isolates had highly antibiotic-resistant profiles and derived from two genotypes. The cumulative incidence of A. baumannii acquisition (colonization or infection) was 36.8%. Patients with A. baumannii had higher mortality and length of stay. Multivariable analysis showed that previous carbapenem use was the only risk factor associated with A. baumannii acquisition (aOR: 4.15, 95% CI: 1.78–9.64). We documented substantial A. baumannii infections and colonization and high levels of clonal transmission. Given the limited treatment options, effective prevention and containment strategies to limit the spread of A. baumannii should be implemented.

Bacterial and fungal coinfections among patients with COVID-19 in Zanjan, Northwest of Iran; a single-center observational with meta-analysis of the literature

“…Our meta-analysis included nine el-igible studies in the field plus the current study (total of ten studies) (23)(24)(25)(26)(27)(28)(29)(30)(31) after an electronic search and removing duplicate and irrelevant records. The distribution of each survey by country is as follows: Spain, USA, Iran, Saudi Arabia, UK, Italy, a multicenter study from Italy, Croatia, Serbia, Slovenia, and two studies from Turkey.…”

Antimicrobial therapy as a risk factor of multidrug-resistant Acinetobacter infection in COVID-19 patients admitted to the intensive care unit

“…A recent study by Ceparano et al identi ed carbapenem exposure but not cephalosporin exposure as a risk factor for A. baumannii isolation in COVID-19 ICU patients. However, in their study carbapenem exposure was much more frequent than cephalosporin exposure, a factor that might have contributed to the results [27].…”

“…Previous studies have found that risk of MDR isolation in COVID-19 patients is associated with broad-spectrum antibiotics like piperacillin-tazobactam and carbapenems, but not with narrower spectrum antibiotics like cephalosporins and aminopenicillins. [26,27]. We identi ed ceftriaxone as an independent and potent risk factor for MDR-Ab superinfection in the setting of COVID-19 ICU patients.…”

“…Empiric antimicrobial therapy is abundantly prescribed in COVID-19 patients with no evidence of bacterial superinfection, while current guidelines do not speci cally address this issue [18, 24,25]. Some of the antimicrobials have been linked to the risk of superinfections by multidrug-resistant bacteria in COVID-19 patients; however, the evidence is still relatively weak [26,27]. Overuse of antibiotics in COVID-19 patients is potentially manageable.…”

Molecular Characterization and Antibiogram of Acinetobacter baumannii Clinical Isolates Recovered from the Patients with Ventilator-Associated Pneumonia

“…Since the emergence of SARS-CoV-2 in 2019, numerous studies have been reported worldwide with a high incidence of carbapenem-resistant A. baumannii among the COVID-19 patients admitted to ICUs [ 6 ]. In the ICU, Acinetobacter baumannii has been reported as one of the most common bacteria responsible for severe hospital-acquired infection, with a high mortality rate ranging from 45% to over 80% when the causative infectious agent is extensively drug-resistant (XDR) [ 7 ].…”