Abstract
ObjectivesSuperinfections 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.MethodsThis 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).ResultsDuring 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.ConclusionsOur 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.
Highlights
Since the end of 2019 the Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread globally affectingThe data about superinfections complicating COVID-19 are scant, and a significant proportion of these patients are treated with empiric broad spectrum antibiotic therapy that increase the risk to develop infections caused by multidrug-resistant (MDR) pathogens [5, 6]
We evaluated risk factor for acquisition of multidrug-resistant Acinetobacter baumannii (MDR-AB) infections in intensive care unit (ICU) patients hospitalized for COVID-19 or other etiology, 30-days mortality in all study population, and risk factors associated with development of bloodstream infection (BSI)
No differences were observed between COVID-19 and other patients related to the median age, Charlson Comorbidity Index, length of hospitalization, and ICU stay, SAPS II at time of admission, procedures, clinical and laboratory findings at time of infection, duration of antibiotic therapy, development of septic shock, 30-days mortality
Summary
The data about superinfections complicating COVID-19 are scant, and a significant proportion of these patients are treated with empiric broad spectrum antibiotic therapy that increase the risk to develop infections caused by multidrug-resistant (MDR) pathogens [5, 6]. Inappropriate therapy and limited therapeutic options are responsible for negative impact on outcome and this infection is associated with high mortality rates, especially in ICU patients [10, 11]. The aim of our study was to evaluate the impact of MDRAB infections on outcome of patients with COVID-19 requiring ICU admission, comparing with non-COVID-19 patients with MDR-AB infections hospitalized in the same ward. We evaluated risk factor for acquisition of MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology, 30-days mortality in all study population, and risk factors associated with development of bloodstream infection (BSI)
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