Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units

Patel, Ashka; Emerick, Michele; Cabunoc, Marie K.; Williams, Michelle; Preas, Michael Anne; Schrank, Gregory; Rabinowitz, Ronald; Luethy, Paul M.; Johnson, J. Kristie; Leekha, Surbhi

doi:10.3201/eid2704.204036

Cited by 78 publications

(68 citation statements)

References 9 publications

(14 reference statements)

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“…Of interest, our experience highlighted the importance of superinfections caused by Gram-negative strains in ICU, including COVID-19 patients. Of importance, a rapid spread of MDR gram-negative bacteria among patients in dedicated coronavirus disease care units was recently observed [ 16 ]. In a recent meta-analysis, 19% of patients with COVID-19 showed co-infections and 24% superinfections; the presence of either co-infection or superinfection was associated with poor outcomes, including increased mortality [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The greater the presence of patient co-morbidities, the more frequent the finding of co-incident infections [125,135]. Gram-negative bacillus infections are associated with increased hospital stay and severe COVID-19 [118,140,[157][158][159][160]. They more often arise either in the respiratory tract, with intravenous access devices, or with genitourinary foci [145,155,156,158,160].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Infectionsmentioning

confidence: 99%

“…They more often arise either in the respiratory tract, with intravenous access devices, or with genitourinary foci [145,155,156,158,160]. Bacteremias tend to be less common but are more likely to be seen with intensive care patients [77,145,156,159,161]. A low rate of COVID-19-associated community-acquired bacteremia has been reported despite the high frequency of COVID-19-related deaths [162].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Infectionsmentioning

confidence: 99%

“…Cusumano et al [163] particularly find that Staphylococcus aureus bacteremia may be an important predictor of worse outcome. There is an increasing antibiotic resistance profile with co-infection [122,123,127,135,137,140,142,144,146,157,159,160,163,164]. For example, some American centers have been particularly inundated with multi-resistant coliforms [135,157].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Infectionsmentioning

confidence: 99%

“…The phenomenon of COVID-19 coinfection with bacteria that are existing with or evolving hypervirulent traits is in its infancy for research [148]. Changes to usual hospital infection control in times of complicating patient surge must be considered in the context of increasing nosocomial infection [159]. Imperative in the control of both COVID-19 and associated nosocomial infections is the due regard that must be given to appropriate environmental containment strategies [6,165].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Infectionsmentioning

confidence: 99%

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