Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España

Nebreda-Mayoral, Teresa; Miguel-Gómez, María Antonia; March-Rosselló, Gabriel Alberto; Puente-Fuertes, Lucía; Cantón-Benito, Elena; Martínez-García, Ana María; Muñoz-Martín, Ana Belén; Orduña-Domingo, Antonio

doi:10.1016/j.eimc.2020.11.003

Cited by 39 publications

(26 citation statements)

References 27 publications

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“…Higher incidence of MDR A. baumannii coinfection has been documented in a study from Egypt (2.7%; seven out of 260 COVID-19 hospitalized patients; susceptible only to tigecycline and fluoroquinolones; bearing resistance genes NDM-1, TEM, and CTX-M) [196]. A recent study in hospitalized COVID-19 patients from Spain showed that coinfection with A. baumannii was apparent in 2.4% of hospitalized patients (17 out of 712; 16 out of these 17 patients in ICU) and it has been the strongest determinant of mortality with OR 9.329 (95% CI: 2.289 to 38.02; p = 0.002; higher than sex, bacteriemia, and number of comorbidities) [197]. A study from an Iranian ICU reported coinfection with MDR A. baumannii in 17 out of 19 COVID-19 patients (89.5%; no MBL-producing strain; 52% resistance rate to colistin), while all these patients died [198].…”

Section: Sars-cov-2 and Resistant A Baumannii Coinfectionsmentioning

confidence: 99%

Acinetobacter baumannii Antibiotic Resistance Mechanisms

et al. 2021

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Acinetobacter baumannii is a Gram-negative ESKAPE microorganism that poses a threat to public health by causing severe and invasive (mostly nosocomial) infections linked with high mortality rates. During the last years, this pathogen displayed multidrug resistance (MDR), mainly due to extensive antibiotic abuse and poor stewardship. MDR isolates are associated with medical history of long hospitalization stays, presence of catheters, and mechanical ventilation, while immunocompromised and severely ill hosts predispose to invasive infections. Next-generation sequencing techniques have revolutionized diagnosis of severe A. baumannii infections, contributing to timely diagnosis and personalized therapeutic regimens according to the identification of the respective resistance genes. The aim of this review is to describe in detail all current knowledge on the genetic background of A. baumannii resistance mechanisms in humans as regards beta-lactams (penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors), aminoglycosides, tetracyclines, fluoroquinolones, macrolides, lincosamides, streptogramin antibiotics, polymyxins, and others (amphenicols, oxazolidinones, rifamycins, fosfomycin, diaminopyrimidines, sulfonamides, glycopeptide, and lipopeptide antibiotics). Mechanisms of antimicrobial resistance refer mainly to regulation of antibiotic transportation through bacterial membranes, alteration of the antibiotic target site, and enzymatic modifications resulting in antibiotic neutralization. Virulence factors that may affect antibiotic susceptibility profiles and confer drug resistance are also being discussed. Reports from cases of A. baumannii coinfection with SARS-CoV-2 during the COVID-19 pandemic in terms of resistance profiles and MDR genes have been investigated.

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Section: Sars-cov-2 and Resistant A Baumannii Coinfectionsmentioning

confidence: 99%

Acinetobacter baumannii Antibiotic Resistance Mechanisms

et al. 2021

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“…The outbreak of A. baumannii was described as one of the main determinants of severity and mortality of ICU patients in [ 106 ]. A New Jersey hospital experienced a large multidrug-resistant OXA-23 CRAb outbreak, primarily involving ICU patients, which extended across multiple units during a surge in COVID-19 cases [ 98 ].…”

Section: Sars-cov-2 and A Baumanniimentioning

confidence: 99%

“…Lescure et al (2020) identified A. baumannii as the responsible agent in a COVID-19 patient of VAP [ 127 ]. A retrospective observational study of all patients admitted for COVID-19 in a University Hospital in Spain showed that 16% presented with fungal or bacterial coinfection/superinfection, and multidrug-resistant A. baumannii was the leading agent in respiratory infections and bacteremia with an outbreak contributing to this result [ 106 ]. Chen et al (2020) also reported that bacterial and fungal coinfections in COVID-19 patients, including one patient that presented with an A. baumannii infection that was highly resistant to antibiotics, cause difficulties with anti-infective treatment, leading to the higher possibility of developing septic shock [ 119 ].…”

Section: Sars-cov-2 and A Baumanniimentioning

confidence: 99%

“…The highest incidence of MDR A. baumannii coinfection was documented in an Egyptian study (2.7%; 7 out of 260 patients hospitalized with COVID-19, susceptible only to tigecycline and fluoroquinolones, having resistance genes NDM-1 , TEM , and CTX-M ) [ 129 ]. Another study in hospitalized COVID-19 patients from Spain showed that coinfection with A. baumannii was apparent in 2.4% of hospitalized patients (17 out of 712; 16 of these 17 patients in ICU); it was the strongest determinant of mortality [ 106 ]. Cultrera et al (2021) compared coinfections in critically ill patients with or without COVID-19, and A. baumannii was the most frequently isolated bacterium found in the three ICUs.…”

Section: Sars-cov-2 and A Baumanniimentioning

confidence: 99%

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Acinetobacter baumannii Infections in Times of COVID-19 Pandemic

2021

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The COVID-19 pandemic has generated an overuse of antimicrobials in critically ill patients. Acinetobacter baumannii frequently causes nosocomial infections, particularly in intensive care units (ICUs), where the incidence has increased over time. Since the WHO declared the COVID-19 pandemic on 12 March 2020, the disease has spread rapidly, and many of the patients infected with SARS-CoV-2 needed to be admitted to the ICU. Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. However, we cannot neglect the increased incidence of antimicrobial resistance, which may be attributed to the excess use of antimicrobial agents during the COVID-19 pandemic. Patients with COVID-19 could be vulnerable to other infections owing to multiple comorbidities with severe COVID-19, prolonged hospitalization, and SARS-CoV-2-associated immune dysfunction. These patients have acquired secondary bacterial infections or superinfections, mainly bacteremia and urinary tract infections. This review will summarize the prevalence of A. baumannii coinfection and secondary infection in patients with COVID-19.

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“…Of the 29 studies, (27.59%) were from France [2,13,[21][22][23][24][25][26]], 4 (13.79%) were from the United Kingdom (UK) [27][28][29][30][31][32], 4 (13.79%) were from the Netherlands [33,34], 2 (6.90%) were from Germany [35,36], 2 (6.90%) were from Spain [15,37], 2 (6.90%) were from Switzerland [14,38], 1 (3.45%) was from the USA [39], 1 (3.45%) was from Belgium [40], 1 (3.45%) was from China[6], 1(3.45%) was from Pakistan [41], 1(3.45%) was from Denmark [42], 1 (3.45%) was from Italy [43] and 1(3.45%) from Mexico [44]. Twelve studies dealt with patients who received mechanical ventilation, eight studies were of patients with ARDS, one study was on extracorporeal membrane oxygenation (ECMO), 1 study looked at acute respiratory failure (ARF), and seven studies included other patients with severe COVID-19 (See additional le 1, supplementary 1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of Patients with COVID‑19‑Associated Pulmonary Aspergillosis (CAPA) in Intensive Care Units: A Systematic Review and Meta-Analysis Of 29 Cohort Studies

Chen¹,

Yin

Ming

et al. 2021

Preprint

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Background Patients with Coronavirus disease 2019 (COVID-19) admitted to an intensive care unit (ICU) might develop COVID-19-related pulmonary Aspergillosis (CAPA). We aimed to identify studies systematically that describe the incidence and risks factors of CAPA, and to assess its outcome. Methods Two authors independently searched ScienceDirect, PubMed, CNKI, MEDLINE (OVID), and MedRXIV from December 31, 2019 to Feb 27, 2021. We included observational cohort studies that investigated patients with CAPA admitted to an ICU. We assessed the quality of all included studies using the Newcastle–Ottawa Scale). The meta-analysis was registered with PROSPERO (CRD42021242179).ResultsTwenty-nine cohort studies with 2095 patients with COVID-19 admitted to an ICU and 264 patients who developed to CAPA were included (Pooled incidence: 0.14, 95% confidence interval [CI] = 0.11–0.17). The overall mortality and case fatality rate of CAPA were 0.07 (0.05–0.09) and 0.51 (0.44–0.58), respectively. Patients with COVID‑19 would develop CAPA at 7.28 days after mechanical ventilation (range, 5.48–9.08). Compared with patients without CAPA, those with CAPA had a significantly lower median body mass index (27.32 vs. 28.97 kg/m2, P = 0.034), higher median creatinine level (127.94 vs. 88.23 µmol/L, P = 014), and were more likely to receive corticosteroids therapy (41.0% vs. 38.0%, risk ratio [RR] = 1.98, 95% CI=1.08–3.63) and renal replacement therapy (42.0% vs. 28.2%, RR = 1.61, 95% CI=1.04–2.50) during admission. Remarkably, patients with CAPA were associated significantly with a 1.66‑fold higher mortality (RR = 1.66, 95% CI=1.31–2.12) without significant heterogeneity and publication bias. ConclusionsPatients with COVID-19 admitted to an ICU might develop CAPA and have higher all‑cause mortality. We recommend conducting prospective screening for CAPA among patients with severe COVID-19, especially for those who receive mechanical ventilation over 7 days.

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Infección bacteriana/fúngica en pacientes con COVID-19 ingresados en un hospital de tercer nivel de Castilla y León, España

Cited by 39 publications

References 27 publications

Acinetobacter baumannii Antibiotic Resistance Mechanisms

Acinetobacter baumannii Antibiotic Resistance Mechanisms

Acinetobacter baumannii Infections in Times of COVID-19 Pandemic

Incidence, Risk Factors, and Outcomes of Patients with COVID‑19‑Associated Pulmonary Aspergillosis (CAPA) in Intensive Care Units: A Systematic Review and Meta-Analysis Of 29 Cohort Studies

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