Abstract
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 piperacillin-tazobactam 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.
Keywords:
COVID-19; ICU; MDR; SARS-CoV-2; outcome.
MeSH terms
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Acinetobacter Infections / drug therapy
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Acinetobacter Infections / microbiology
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Acinetobacter Infections / mortality*
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Acinetobacter Infections / virology
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Acinetobacter baumannii / drug effects
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Acinetobacter baumannii / growth & development
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Acinetobacter baumannii / pathogenicity
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Adult
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Aged
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Anti-Bacterial Agents / therapeutic use
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Aspirin / therapeutic use
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COVID-19 / microbiology
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COVID-19 / mortality*
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COVID-19 / virology
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COVID-19 Drug Treatment
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Carbapenems / therapeutic use
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Critical Illness
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Drug Resistance, Multiple, Bacterial*
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Female
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Hospital Mortality
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Humans
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Intensive Care Units
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Klebsiella Infections / drug therapy
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Klebsiella Infections / microbiology
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Klebsiella Infections / mortality*
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Klebsiella Infections / virology
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Klebsiella pneumoniae / drug effects
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Klebsiella pneumoniae / growth & development
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Klebsiella pneumoniae / pathogenicity
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Length of Stay / statistics & numerical data
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Male
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Middle Aged
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Opportunistic Infections / drug therapy
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Opportunistic Infections / microbiology
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Opportunistic Infections / mortality*
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Opportunistic Infections / virology
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Piperacillin, Tazobactam Drug Combination / therapeutic use
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Pneumonia / drug therapy
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Pneumonia / microbiology
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Pneumonia / mortality*
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Pneumonia / virology
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Retrospective Studies
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SARS-CoV-2 / drug effects
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SARS-CoV-2 / pathogenicity*
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SARS-CoV-2 / physiology
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Steroids / therapeutic use
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Survival Analysis
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Treatment Outcome
Substances
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Anti-Bacterial Agents
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Carbapenems
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Steroids
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Piperacillin, Tazobactam Drug Combination
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Aspirin