Superinfections in a Cohort of Patients with COVID-19 Admitted to Intensive Care: Impact of Gram Negative Resistance.

Abstract

Background: some studies have shown that superinfection during pandemics may have contributed to high mortality. Our objective is to identify the frequency, types and aetiology of superinfections in patients with Covid-19 admitted to the intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and hospital mortality.Methods: retrospective cohort of adult patients admitted to the ICU for more than 48 hours between March to May 2020. Comparisons of groups with and without ICU- acquired infection were established.Results: a total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. Most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% Acinetobacter and in 57% K.pneumoniae. The most prevalent infection was ventilator-associated pneumonia (VAP) in 57.9% of patients with bacterial superinfection, or 17.3% of all COVID-19 patients admitted to ICU, followed by tracheobronchitis, in 26.3%. Patients with superinfection had a longer ICU stay (40.0 vs. 17; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0; p = 0.003). There were 35.6% deaths overall, of which 39.7% of the patients had superinfection; in those who survived, 24.4% had a superinfection (OR 2.041; 95% CI 1.080–3.859).Conclusion: a high incidence of superinfections was seen, mostly caused by Gram-negative bacteria. The most common infection was VAP. Superinfections were associated with longer ICU stay and MV use and higher mortality.

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

“…High rates of carbapenem resistance in Acinetobacter spp., K. pneumoniae and other Enterobacterales have also been reported in single studies where the above microorganisms represented the predominant causes of BSI in patients hospitalized with 13). Both prevalence of BSI and rates of resistance, however, displayed wide heterogeneity by hospital and geographical area (8)(9)(10)(11)(12)(13). Since Italy is the European country with the estimated highest number of antibiotic-resistant infections and associated deaths (14), it is necessary to collect updated information on the microbiological profile of BSI and on possible determinants of antimicrobial resistance in patients with COVID-19, in order to identify risk factors, improve outcomes, and reduce the occurrence of antimicrobial resistance.…”

“…higher mortality and shorter time to death (1,7,8,13,19,20). In addition, higher antibiotic resistance rates have been documented in the BSI bacterial pathogens (3,7).…”

“…A systematic review and meta-analysis showed a high prevalence of antimicrobial resistance (AMR) in COVID-19 patients, with the most common microorganisms represented by MRSA, carbapenem-resistant A. baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa, and multi-drug resistant Candida auris (11). High rates of carbapenem resistance in Acinetobacter spp., K. pneumoniae and other Enterobacterales have also been reported in single studies where the above microorganisms represented the predominant causes of BSI in patients hospitalized with 13). Both prevalence of BSI and rates of resistance, however, displayed wide heterogeneity by hospital and geographical area (8)(9)(10)(11)(12)(13).…”

“…Other studies have addressed the prevalence and characteristics of antimicrobial resistance in patients with COVID-19, suggesting increased rates of drug resistance and different antimicrobial resistance profile compared to the pre-COVID-19 era or to non-COVID-19 populations (3,8,(11)(12)(13). Baker et al reported that COVID-19 surges were significantly associated with increases in rates of hospital-onset bloodstream infections and multidrug resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp.…”

“…(VRE), and Gramnegative organisms (3). Other studies reported a high prevalence of Acinetobacter baumannii in COVID-19 associated BSIs (8,12,13). A systematic review and meta-analysis showed a high prevalence of antimicrobial resistance (AMR) in COVID-19 patients, with the most common microorganisms represented by MRSA, carbapenem-resistant A. baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa, and multi-drug resistant Candida auris (11).…”