Annals of Medicine (Jan 2021)

Enterococcal bloodstream infections in critically ill patients with COVID-19: a case series

  • Daniele Roberto Giacobbe,
  • Laura Labate,
  • Stefania Tutino,
  • Federico Baldi,
  • Chiara Russo,
  • Chiara Robba,
  • Lorenzo Ball,
  • Silvia Dettori,
  • Anna Marchese,
  • Chiara Dentone,
  • Laura Magnasco,
  • Francesca Crea,
  • Edward Willison,
  • Federica Briano,
  • Denise Battaglini,
  • Nicolò Patroniti,
  • Iole Brunetti,
  • Paolo Pelosi,
  • Matteo Bassetti

DOI
https://doi.org/10.1080/07853890.2021.1988695
Journal volume & issue
Vol. 53, no. 1
pp. 1779 – 1786

Abstract

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AbstractBackground An unexpected high prevalence of enterococcal bloodstream infection (BSI) has been observed in critically ill patients with COVID-19 in the intensive care unit (ICU).Materials and methods The primary objective was to describe the characteristics of ICU-acquired enterococcal BSI in critically ill patients with COVID-19. A secondary objective was to exploratorily assess the predictors of 30-day mortality in critically ill COVID-19 patients with ICU-acquired enterococcal BSI.Results During the study period, 223 patients with COVID-19 were admitted to COVID-19-dedicated ICUs in our centre. Overall, 51 episodes of enterococcal BSI, occurring in 43 patients, were registered. 29 (56.9%) and 22 (43.1%) BSI were caused by Enterococcus faecalis and Enterococcus faecium, respectively. The cumulative incidence of ICU-acquired enterococcal BSI was of 229 episodes per 1000 ICU admissions (95% mid-p confidence interval [CI] 172–298). Most patients received an empirical therapy with at least one agent showing in vitro activity against the blood isolate (38/43, 88%). The crude 30-day mortality was 42% (18/43) and 57% (4/7) in the entire series and in patients with vancomycin-resistant E. faecium BSI, respectively. The sequential organ failure assessment (SOFA) score showed an independent association with increased mortality (odds ratio 1.32 per one-point increase, with 95% confidence interval 1.04–1.66, p = .021).Conclusions The cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19. Our results suggest a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.KEY MESSAGESThe cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19.The crude 30-day mortality of enterococcal BSI in critically ill patients with COVID-19 may be higher than 40%.There could be a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.

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