Multidrug-Resistant Infections and Outcome of Critically Ill Patients with Coronavirus Disease 2019: A Single Center Experience
Arta Karruli, Filomena Boccia, Massimo Gagliardi, Fabian Patauner, Maria Paola Ursi, Pino Sommese, Rosanna De Rosa, Patrizia Murino, Giuseppe Ruocco, Antonio Corcione, Roberto Andini, Rosa Zampino, Emanuele Durante-Mangoni
Microbial Drug Resistance, doi:10.1089/mdr.2020.0489
Background: The aim of this study was to assess the drivers of multidrug-resistant (MDR) bacterial infection development in coronavirus disease 2019 (COVID-19) and its impact on patient outcome. Methods: Retrospective analysis on data from 32 consecutive patients with COVID-19, admitted to our intensive care unit (ICU) from March to May 2020. Outcomes considered were MDR infection and ICU mortality. Results: Fifty percent of patients developed an MDR infection during ICU stay after a median time of 8 [4-11] days. Most common MDR pathogens were carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, causing bloodstream infections and pneumonia. MDR infections were linked to a higher length of ICU stay ( p = 0.002), steroid therapy ( p = 0.011), and associated with a lower ICU mortality (odds ratio: 0.439, 95% confidence interval: 0.251-0.763; p < 0.001). Low-dose aspirin intake was associated with both MDR infection ( p = 0.043) and survival ( p = 0.015). Among MDR patients, mortality was related with piperacillintazobactam use ( p = 0.035) and an earlier onset of MDR infection ( p = 0.042). Conclusions: MDR infections were a common complication in critically ill COVID-19 patients at our center. MDR risk was higher among those dwelling longer in the ICU and receiving steroids. However, MDR infections were not associated with a worse outcome.
Ethics Approval The study and its observational procedures were approved by our institutional ethics committee.
Authors' Contributions All authors have contributed to and agreed on the content of the article, and the respective roles of each author are as follows: A.K., F.B., R.Z., and E.D.-M. worked on concept of the study; M.G., F.P., M.P.U., and P.S. worked on data collection and data interpretation; A.K., R.Z., and E.D.-M. drafted the article. All authors read, critically revised, and approved the final version of the article.
Disclosure Statement Authors have no conflict of interest to disclose relevant to the content of this study. E.D.-M. received grant support and personal fees, outside of this study, from Roche, Pfizer, MSD, Angelini, Bio-Merieux, Abbvie, Nordic Pharma, Sanofi-Aventis, Medtronic, and DiaSorin. R.Z. and R.A. received personal fees, outside of this study, from Nordic Pharma.
Supplementary Material Supplementary Table S1
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