tetano
Editor, Senior Moderator
J Hosp Infect
. 2021 Feb 6;S0195-6701(21)00047-5.
doi: 10.1016/j.jhin.2021.01.027. Online ahead of print.
Clinical characteristics and risk factors for the isolation of multidrug-resistant Gram-negative bacteria from critically ill patients with Coronavirus Disease 2019
Anas Baiou[SUP] 1 [/SUP], Abdurrahman A Elbuzidi[SUP] 1 [/SUP], Dana Bakdach[SUP] 2 [/SUP], Ahmed Zaqout[SUP] 3 [/SUP], Khalid M Alarbi[SUP] 4 [/SUP], Awadh A Bintaher[SUP] 1 [/SUP], Maisa M B Ali[SUP] 3 [/SUP], Anam M Elarabi[SUP] 5 [/SUP], Gawahir A M Ali[SUP] 3 [/SUP], Joanne Daghfal[SUP] 6 [/SUP], Muna A Almaslamani[SUP] 3 [/SUP], Abdul Salam S Ibrahim[SUP] 1 [/SUP], Abdullatif Alkhal[SUP] 3 [/SUP], Ali S Omrani[SUP] 7 [/SUP]
Affiliations
Abstract
Background: We investigated the clinical characteristics and risk factors for the isolation of multidrug resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients.
Methods: We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls).
Results: Seventy-eight cases were identified (4.5 per 1,000 ICU days, 95% confidence interval [CI] 3.6-5.7). Out of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agent within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P = 0.19). Mechanical ventilation days (adjusted odds ratio [aOR] 1.062, 95% CI 1.012 to 1.114; P 0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (aOR 2.426, 95% CI 0.833 to 7.069; P = 0.104).
Conclusion: In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimising the use of invasive devices, and to remove them as soon as their presence is no longer necessary.
Keywords: COVID-19; SARS-CoV-2; coronavirus; multidrug resistance.
. 2021 Feb 6;S0195-6701(21)00047-5.
doi: 10.1016/j.jhin.2021.01.027. Online ahead of print.
Clinical characteristics and risk factors for the isolation of multidrug-resistant Gram-negative bacteria from critically ill patients with Coronavirus Disease 2019
Anas Baiou[SUP] 1 [/SUP], Abdurrahman A Elbuzidi[SUP] 1 [/SUP], Dana Bakdach[SUP] 2 [/SUP], Ahmed Zaqout[SUP] 3 [/SUP], Khalid M Alarbi[SUP] 4 [/SUP], Awadh A Bintaher[SUP] 1 [/SUP], Maisa M B Ali[SUP] 3 [/SUP], Anam M Elarabi[SUP] 5 [/SUP], Gawahir A M Ali[SUP] 3 [/SUP], Joanne Daghfal[SUP] 6 [/SUP], Muna A Almaslamani[SUP] 3 [/SUP], Abdul Salam S Ibrahim[SUP] 1 [/SUP], Abdullatif Alkhal[SUP] 3 [/SUP], Ali S Omrani[SUP] 7 [/SUP]
Affiliations
- PMID: 33561503
- DOI: 10.1016/j.jhin.2021.01.027
Abstract
Background: We investigated the clinical characteristics and risk factors for the isolation of multidrug resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients.
Methods: We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls).
Results: Seventy-eight cases were identified (4.5 per 1,000 ICU days, 95% confidence interval [CI] 3.6-5.7). Out of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agent within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P = 0.19). Mechanical ventilation days (adjusted odds ratio [aOR] 1.062, 95% CI 1.012 to 1.114; P 0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (aOR 2.426, 95% CI 0.833 to 7.069; P = 0.104).
Conclusion: In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimising the use of invasive devices, and to remove them as soon as their presence is no longer necessary.
Keywords: COVID-19; SARS-CoV-2; coronavirus; multidrug resistance.