Clinical characteristics and risk factors for the isolation of multi-drug-resistant Gram-negative bacteria from critically ill patients with COVID-19

We investigated the clinical characteristics and risk factors for the isolation of multi-drug-resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), w...

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Published in:	The Journal of hospital infection Vol. 110; pp. 165 - 171
Main Authors:	Baiou, A., Elbuzidi, A.A., Bakdach, D., Zaqout, A., Alarbi, K.M., Bintaher, A.A., Ali, M.M.B., Elarabi, A.M., Ali, G.A.M., Daghfal, J., Almaslamani, M.A., Ibrahim, A.S.S., Alkhal, A., Omrani, A.S.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-04-2021 The Healthcare Infection Society. Published by Elsevier Ltd
Subjects:	Adult Coronavirus COVID-19 COVID-19 - epidemiology COVID-19 - microbiology COVID-19 - physiopathology Critical Illness Drug Resistance, Multiple, Bacterial Female Gram-Negative Bacteria - isolation & purification Gram-Negative Bacterial Infections - epidemiology Humans Incidence Male Middle Aged Multi-drug resistance Prevalence Qatar - epidemiology Retrospective Studies Risk Factors SARS-CoV-2 Qatar COVID-19 SARS-CoV-2 Multi-drug resistance Coronavirus
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Summary:	We investigated the clinical characteristics and risk factors for the isolation of multi-drug-resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. 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). Seventy-eight cases were identified (4.5 per 1000 intensive care unit (ICU) days, 95% confidence interval (CI) 3.6–5.7). 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 agents 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 1.062, 95% CI 1.012–1.114; 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 (adjusted odds ratio 2.426, 95% CI 0.833–7.069; P= 0.104). In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimizing the use of invasive devices, and to remove them as soon as their presence is no longer necessary.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0195-6701 1532-2939
DOI:	10.1016/j.jhin.2021.01.027