Publication date: Jan 10, 2025
Background: Bacterial superinfections are common complications during viral infections, but the impact of multidrug-resistant (MDR) pathogens in critically ill patients affected by coronavirus disease 2019 (COVID-19) is still debated. Methods: This is an observational, monocentric, and prospective study designed to investigate the incidence, risk factors, and outcomes of MDR bacterial superinfections in COVID-19 patients admitted to the intensive care unit (ICU). Results: A high incidence of superinfections (66%, 159/241) was observed: ventilator-associated pneumonia (VAP) (65%, 104/159) and bloodstream infection (BSI, 32%, 51/159) were the most common. Superinfections, Extra-Corporeal Membrane Oxygenation (ECMO) support, and prone positioning increased the risk of death five, four, and more-than-two times, respectively (OR = 5. 431, IC 95%: 1. 637-18. 014; 4. 462, IC 95%: 1. 616-12. 324 and 2. 346, IC 95%: 1. 127-4. 883). MDR bacteria were identified in 61% of patients with superinfection, with a cumulative incidence of 37. 2% at day 14. Carbapenem-resistant Acinetobacter baumannii (CR-AB) and CR-Klebsiella pneumoniae (CR-KP) were the most common causative agents (24. 3% and 13. 7%). CR-AB was found to significantly increase both ICU and in-hospital mortality (76. 4% and 78. 2%), whereas CR-KP had no direct impact on mortality. Prior rectal colonization (p < 0. 0001), mechanical ventilation (p = 0. 0017), a prolonged ICU stay (p < 0. 0001), the use of iNO (p = 0. 0082), vasopressors (p = 0. 0025), curarization (p = 0. 0004), and prone positioning (p = 0. 0084) were found to be risk factors for CR-AB. Conclusions: Critically ill COVID-19 patients are at high risk of developing MDR superinfection. While CR-KP had no direct impact on mortality, CR-AB appeared to increase ICU and in-hospital mortality.
Open Access PDF
Semantics
| Type | Source | Name |
|---|---|---|
| disease | IDO | bacteria |
| disease | MESH | COVID-19 |
| disease | MESH | Critically Ill |
| disease | MESH | superinfections |
| disease | MESH | complications |
| disease | MESH | viral infections |
| disease | MESH | ventilator-associated pneumonia |
| disease | MESH | bloodstream infection |
| disease | MESH | death |
| drug | DRUGBANK | Inosine |
| disease | MESH | Emergency |
| disease | MESH | Infectious Diseases |
| disease | MESH | pneumonia |
| disease | IDO | organism |
| disease | MESH | infections |
| disease | IDO | infection |
| drug | DRUGBANK | Etoperidone |
| disease | IDO | process |
| disease | MESH | respiratory failure |
| disease | IDO | blood |
| drug | DRUGBANK | Dimercaprol |
| disease | MESH | comorbidity |
| disease | IDO | susceptibility |
| disease | MESH | septic shock |
| disease | MESH | pleural effusion |
| disease | MESH | ascitic fluid |
| disease | MESH | diabetes mellitus |
| disease | MESH | cardiovascular disease |
| disease | MESH | lung disease |
| drug | DRUGBANK | Nitric Oxide |
| drug | DRUGBANK | Trestolone |