Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit

Abstract

Objectives Superinfections in patients hospitalized in intensive care unit (ICU) are an important and challenging complication, also in COVID-19. However, no definitive data are available about the role of multidrug-resistant Acinetobacter baumannii (MDR-AB) in COVID-19. Methods This was a single-center, cross-sectional study including patients with MDR-AB infections admitted to ICU with or without COVID-19, between January 2019 and January 2021. The primary objective of the study was to evaluate risk factor for MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology. The secondary endpoints were 30-days mortality in all study population and risk factors associated with development of bloodstream infection (BSI). Results During the study period 32 adults with COVID-19 were enrolled and compared with 115 patients admitted in the same ICU for other reasons. We observed a total of 114 deaths, with a survival rate of 29.3%: 18.8% in COVID-19 and 32.2% in control group. Relative risk for MDR-AB infection in COVID-19 showed that serum lactate levels mmol/l > 2, Acinetobacter baumannii colonization, BSI and steroid therapy were observed more frequently in COVID-19 patients. Cox regression analysis showed that serum lactate levels > 2 mmol/l, Acinetobacter baumannii colonization, BSI, and steroid therapy were associated with 30-days mortality. Finally, patients with COVID-19, white blood cells count > 11,000 mm3, serum lactate levels > 2 mmol/l, infections at time of ICU admission, Acinetobacter baumannii colonization, and steroid therapy were independently associated with development of BSI. Conclusions Our data highlight the impact of BSI on outcome, the role of Acinetobacter baumannii colonization and the use of steroids on the risk to develop MDR-AB infections also during COVID-19.

The Impact of COVID-19 on the Profile of Hospital-Acquired Infections in Adult Intensive Care Units

“…Though not unexpected, the rise of PNs, many of which caused by CRA, brings a new challenge when it comes to HAI management. Increased rates of HAIs in ICUs that treat COVID-19 patients are being reported in various countries and support our findings [4,34], likely as a result of the inability to fully comply with the standard practices of infection control during this unprecedented time [12,35,36]. Another risk for promoting resistance in patients hospitalized for COVID-19 is the use of immunosuppressive therapy, though studies are showing conflicting results regarding its contribution to resistance [37,38].…”

“…Second, it also limited our ability to look at the interaction between antimicrobial use that extends beyond window of 48h before and after admission, given the established relationship of prolonged antimicrobial use and development of resistance [65]. And third, the extent to which immunosuppressive drugs (such as corticosteroids and/or tocilizumab) used in COVID-19 treatment played a role in the development of AMR [12].…”

“…Pathogens such as carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-resistant Acinetobacter baumannii (CRA) have become hard to treat as carbapenems, the mainstay of both empiric and targeted therapy, are increasingly not fit for use [10]. This has become even more important during the pandemic, as outbreaks of both CRE and CRA are increasingly reported worldwide [11][12][13][14], affecting patient outcomes that are already compromised due to COVID-19. Because of these challenges, rigorous local surveillance is critical, as it enables continuous revisions of empiric therapy guidelines and improvement in antimicrobial stewardship, both for initiation of therapy and its de-escalation [15,16].…”

Impact of SARS-CoV-2 Epidemic on Antimicrobial Resistance: A Literature Review

“…Along with CRE, another important nosocomial threat is represented by CRAB secondary infections. To date, multiple outbreaks of CRAB have been reported in COVID-19-dedicated hospitals [43,[53][54][55][56][57]; in addition, a recent report from Italy demonstrated that the overall incidence of CRAB infections increased from 5.1 per 10,000 ICU-patientdays in January-April 2019 to 26.4 per 10,000 ICU-patient-days in January-April 2020, suggesting a worsening of CRAB spreading in ICUs strictly correlated with the occurrence of the COVID-19 pandemic [58]. Notably, CRAB infections and colonization represent an important risk factor for morbidity and mortality due to the extensive antimicrobial resistance spectrum of these bacteria and are a renowned complication of prolonged ICU stays.…”

Effectiveness of Gaseous Ozone as a Disinfectant for Nosocomial Pathogens in a Healthcare Emergency Room

“…For instance, MRSA, as a multidrug-resistant bacteria and common nosocomial infection pathogen, was isolated in the current study, and its growth was downregulated successfully through O3 gas application. MRSA is widely known to be highly prevalent in emergency departments and healthcare facilities [31,32]. Similarly, the diversity of Gram-positive bacteria was isolated in the current study, including Grampositive bacilli, CONS, bacillus, aerobic spore-forming, actinomycetes, diphtheroids spp., Nocardia, and Filamentous bacteria.…”