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

A Baiou, A A Elbuzidi, D Bakdach, A Zaqout, K M Alarbi, A A Bintaher, M M B Ali, A M Elarabi, G A M Ali, J Daghfal, M A Almaslamani, A S S Ibrahim, A Alkhal, A S Omrani, A Baiou, A A Elbuzidi, D Bakdach, A Zaqout, K M Alarbi, A A Bintaher, M M B Ali, A M Elarabi, G A M Ali, J Daghfal, M A Almaslamani, A S S Ibrahim, A Alkhal, A S Omrani

Abstract

Background: 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.

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 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).

Conclusion: 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.

Keywords: COVID-19; Coronavirus; Multi-drug resistance; SARS-CoV-2.

Copyright © 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Species breakdown for multi-drug resistant Gram-negative bacteria isolated from critically ill COVID-19 patients. Data presented as number (percentage).

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