Microbiological characteristics of bacteremias among COVID-19 hospitalized patients in a tertiary referral hospital in Northern Greece during the second epidemic wave

Abstract

Northern Greece was struck by an intense second COVID-19 epidemic wave during the fall of 2020. Because of the coinciding silent epidemic of MDR organisms the handling of COVID-19 patients became even more challenging. In the present study, the microbiological characteristics of bacteraemias in confirmed cases of hospitalized COVID-19 patients were determined. Data from 1165 patients hospitalized between September and December 2020 were reviewed regarding the frequency of bloodstream infections, the epidemiology and the antibiotic susceptibility profiles of the causative bacteria. The hospital's antibiotic susceptibility data for all major nosocomial pathogens isolated from bacteremias of COVID-19 patients between September-December 2020 versus September-December 2019 bacteremias were also compared. Overall, 122 patients developed bacteremia (10.47%). The average of time interval between hospitalization date and development of bacteremia was 13.98 days. Admission to ICU occurred in 98 out of 122 patients with an average time of stay 15.85 days and 90.81% in-hospital mortality. In total, 166 pathogens were recovered including 114 Gram-negative bacteria and 52 Gram-positive cocci. Acinetobacter baumannii were the most frequent (n = 51) followed by Klebsiella pneumoniae (n = 45) and Enterococcus faecium (n = 31). Bacteremias in hospitalized COVID-19 patients were related with prolonged time of hospitalization and higher in-hospital mortality and the isolated microorganisms represented the bacterial species that were present in our hospital before the COVID-19 pandemic. Worryingly, the antibiotic resistance rates were increased compared to the pre-pandemic era for all major opportunistic bacterial pathogens. The pandemic highlighted the need for continuous surveillance of patients with prolonged hospitalization.

Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients’ Outcome

“…As epidemiology of BSI in COVID-19 patients, similar to non-COVID-19 patients, varies among countries and continents, continuous surveillance is required [ 12 ]. Our study demonstrated high rates of MDR pathogens, as also reported from another hospital in our country [ 20 ]; both studies mirror the endemic spread of MDRO, especially Gram-negatives. Protonotariou et al reported a higher rate of MDRO (58% vs. 46% in our study) possibly because ICU patients prevailed in that cohort.…”

“…The incidence of BSI in COVID-19 patients and their outcome has been studied mostly in ICU or in mixed populations of both ICU and medical wards [ 11 ]. Furthermore, epidemiology of bacterial and fungal pathogens in BSI of patients with COVID-19 was mostly described in ICU departments with endemicity of multidrug antimicrobial resistance, but not in non-ICU COVID-19 settings [ 20 ].…”

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

“…Several studies, systematic reviews and metanalyses have evaluated prevalence, microbiological characteristics, clinical course and outcomes of secondary infections in patients hospitalized with COVID-19 (1)(2)(3)(4)(5)(6)(7)(8).…”

Vaccination with a combination of planktonic and biofilm virulence factors confers protection against carbapenem-resistant Acinetobacter baumannii strains

“…have severely affected the treatment of patients admitted in ICUs 1 – 3 . Multidrug-resistant A. baumannii was one of the most frequent pathogens isolated from patients hospitalized in the ICU for severe COVID-19 pneumonia 4 or bacteremia 5 . In 2021, the World Health Organization (WHO) introduced antibacterial vaccines as an effective tool to reduce antibiotic resistance 6 .…”