Unexpectedly High Frequency of Enterococcal Bloodstream Infections in Coronavirus Disease 2019 Patients Admitted to an Italian ICU: An Observational Study

Bonazzetti, Cecilia; Morena, Valentina; Giacomelli, Andrea; Oreni, Letizia; Casalini, Giacomo; Galimberti, Laura; Bolis, Matteo; Rimoldi, Matteo; Ballone, Elisabetta; Colombo, Riccardo; Ridolfo, Anna Lisa; Antinori, Spinello

doi:10.1097/ccm.0000000000004748

Cited by 92 publications

(100 citation statements)

References 29 publications

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“…Bacterial superinfection with Staphylococcus is a long-recognized consequence of influenza and important cause of morbidity and mortality ( 6 , 7 ), so further studies will be useful to determine if similar mechanisms operate during COVID-19. We also noted several patients with high relative abundances of Enterococcus , which was recently described as a common cause of bloodstream infection in critically ill COVID-19 patients ( 40 ).…”

Section: Discussionsupporting

confidence: 56%

Signatures of COVID-19 severity and immune response in the respiratory tract microbiome

Merenstein

Liang

Whiteside

et al. 2021

Preprint

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Rationale: Viral infection of the respiratory tract can be associated with propagating effects on the airway microbiome, and microbiome dysbiosis may influence viral disease. Objective: To define the respiratory tract microbiome in COVID-19 and relationship disease severity, systemic immunologic features, and outcomes. Methods and Measurements: We examined 507 oropharyngeal, nasopharyngeal and endotracheal samples from 83 hospitalized COVID-19 patients, along with non-COVID patients and healthy controls. Bacterial communities were interrogated using 16S rRNA gene sequencing, commensal DNA viruses Anelloviridae and Redondoviridae were quantified by qPCR, and immune features were characterized by lymphocyte/neutrophil (L/N) ratios and deep immune profiling of peripheral blood mononuclear cells (PBMC). Main Results: COVID-19 patients had upper respiratory microbiome dysbiosis, and greater change over time than critically ill patients without COVID-19. Diversity at the first time point correlated inversely with disease severity during hospitalization, and microbiome composition was associated with L/N ratios and PBMC profiles in blood. Intubated patients showed patient-specific and dynamic lung microbiome communities, with prominence of Staphylococcus. Anelloviridae and Redondoviridae showed more frequent colonization and higher titers in severe disease. Machine learning analysis demonstrated that integrated features of the microbiome at early sampling points had high power to discriminate ultimate level of COVID-19 severity. Conclusions: The respiratory tract microbiome and commensal virome are disturbed in COVID-19, correlate with systemic immune parameters, and early microbiome features discriminate disease severity. Future studies should address clinical consequences of airway dysbiosis in COVID-19, possible use as biomarkers, and role of bacterial and viral taxa identified here in COVID-19 pathogenesis.

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Section: Discussionsupporting

confidence: 56%

Signatures of COVID-19 severity and immune response in the respiratory tract microbiome

Merenstein

Liang

Whiteside

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…A large multi-centric cohort study including only COVID-19 highlighted that the most common presumed source was unknown or not reported [ 30 ]. Moreover, the role of bacterial translocation should further be evaluated: a recent monocentric Italian study showed an increased risk for enterococcal BSI among COVID-19 patient, thus suggesting an enteric involvement in patients with severe COVID-19 [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 increased the risk of ICU-acquired bloodstream infections: a case–cohort study from the multicentric OUTCOMEREA network

et al. 2021

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The primary objective of this study was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Subsequently, we performed secondary analyses in order to explain the observed results. Methods: We conducted a matched case-cohort study, based on prospectively collected data from a large ICU cohort in France. Critically ill COVID-19 patients were matched with similar non-COVID-19 patients. ICU-BSI was defined by an infection onset occurring > 48 h after ICU admission. We estimated the effect of COVID-19 on the probability to develop an ICU-BSI using proportional subdistribution hazards models. Results: We identified 321 COVID-19 patients and 1029 eligible controls in 6 ICUs. Finally, 235 COVID-19 patients were matched with 235 non-COVID-19 patients. We observed 43 ICU-BSIs, 35 (14.9%) in the COVID-19 group and 8 (3.4%) in the non-COVID-19 group (p ≤ 0.0001), respectively. ICU-BSIs of COVID-19 patients were more frequently of unknown source (47.4%). COVID-19 patients had an increased probability to develop ICU-BSI, especially after 7 days of ICU admission. Using proportional subdistribution hazards models, COVID-19 increased the daily risk to develop ICU-BSI (sHR 4.50, 95% CI 1.82-11.16, p = 0.0012). Among COVID-19 patients (n = 235), a significantly increased risk for ICU-BSI was detected in patients who received tocilizumab or anakinra (sHR 3.20, 95% CI 1.31-7.81, p = 0.011) but not corticosteroids. Conclusions: Using prospectively collected multicentric data, we showed that the ICU-BSI risk was higher for COVID-19 than non-COVID-19 critically ill patients after seven days of ICU stay. Clinicians should be particularly careful on late ICU-BSIs in COVID-19 patients. Tocilizumab or anakinra may increase the ICU-BSI risk.

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“…Intensive care unit studies in Italy demonstrated an increase in the rate of infections by Klebsiella carbapenemase-resistant, E. coli , and Enterococcus spp., but these studies considered both COVID-19 and no COVID-19 patients [ 24 , 25 ]. Conversely, in a Spanish study carried out in a tertiary hospital for 20 weeks before and during the COVID-19 spread, the mean incidence density of blood infections caused by MDR organisms remained stable, with a value of 0.36 ± 0.42 cases per 1000 occupied bed days in the COVID-19 period and 0.33 ± 0.28 bloodstream infections per 1000 occupied bed days in the period before the national lockdown [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards

et al. 2021

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The impact of the COVID-19 pandemic on multidrug-resistant (MDR) bacteria is unknown. The purpose of this study was to assess prevalence, etiology, and association with mortality of MDR bacteria in older adult patients before and after the first peak of the COVID-19 pandemic in Italy. An observational retrospective study was conducted in two geriatric wards of the Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, and of the INRCA, IRCCS, Ancona, in the Marche Region, Italy, from December 2019 to February 2020 and from May to July 2020. A total of 73 patients (mean age 87.4 ± 5.9, 27.4% men) and 83 cultures (36 pre-COVID-19 and 47 post-COVID-19) were considered. Overall, 46 cultures (55.4%) reported MDR bacteria (50% in pre- and 59.6% in post-COVID-19 period, p = 0.384). MDR bacteria in bloodstream significantly increased in post-COVID-19 period (68.8% vs. 40.0% p = 0.038) and MDR bacteria in urine did not change (51.6 vs. 54.8%, p = 0.799). Escherichia coli was the main MDR bacterium in pre-COVID-19, p = 0.082 and post-COVID-19, p = 0.026. Among patients with MDR infection, in-hospital mortality was 37.5% and 68.8% in pre- and post-COVID-19, respectively (p = 0.104), and mortality at 30 days was higher in post-COVID-19 period (78.9% vs. 27.3%, p = 0.012). An increased number of MDR bacteria in bloodstream and mortality after MDR infection have been observed in the post-COVID-19 period.

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Unexpectedly High Frequency of Enterococcal Bloodstream Infections in Coronavirus Disease 2019 Patients Admitted to an Italian ICU: An Observational Study

Abstract: Supplemental Digital Content is available in the text.

Cited by 92 publications

References 29 publications

Signatures of COVID-19 severity and immune response in the respiratory tract microbiome

Signatures of COVID-19 severity and immune response in the respiratory tract microbiome

COVID-19 increased the risk of ICU-acquired bloodstream infections: a case–cohort study from the multicentric OUTCOMEREA network

Multidrug-Resistant Bacterial Infections in Geriatric Hospitalized Patients before and after the COVID-19 Outbreak: Results from a Retrospective Observational Study in Two Geriatric Wards

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