Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared
Francesco Cogliati Dezza,
Gabriele Arcari,
Federica Alessi,
Serena Valeri,
Ambrogio Curtolo,
Federica Sacco,
Giancarlo Ceccarelli,
Giammarco Raponi,
Francesco Alessandri,
Claudio Maria Mastroianni,
Mario Venditti,
Alessandra Oliva
Affiliations
Francesco Cogliati Dezza
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Gabriele Arcari
Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
Federica Alessi
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Serena Valeri
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Ambrogio Curtolo
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Federica Sacco
Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
Giancarlo Ceccarelli
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Giammarco Raponi
Microbiology and Virology Laboratory, Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
Francesco Alessandri
Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
Claudio Maria Mastroianni
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Mario Venditti
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Alessandra Oliva
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
Two mutually related pandemics are ongoing worldwide: the COVID-19 and antimicrobial resistance pandemics. This study aims to evaluate the impact of COVID-19 on multi-drug-resistant Gram-negative bacteria (MDR-GN) bloodstream infections (BSIs) in a single intensive care unit (ICU). We conducted a retrospective study including patients admitted to the ICU, reorganized for COVID-19 patients’ healthcare, with at least one confirmed MDR-GN BSI during 2019–2020. We compared clinical and microbiological features, incidence density, antibiotic therapy and mortality rate in pre- and during-COVID-19 pandemic periods. We estimated the impact of COVID-19 on mortality by means of univariate Cox regression analyses. A total of 46 patients were included in the study (28 non-COVID-19/18 COVID-19). Overall, 63 BSI episodes occurred (44/19), and non-COVID-19 patients had a higher incidence of MDR-GN BSIs and were more likely to present K. pneumoniae BSIs, while the COVID-19 group showed more A. baumannii BSIs with higher per pathogen incidence. COVID-19 patients presented more critical conditions at the BSI onset, a shorter hospitalization time from BSI to death and higher 30-day mortality rate from BSI onset. COVID-19 and septic shock were associated with 30-day mortality from MDR-GN BSIs, while early active therapy was a protective factor. In conclusion, COVID-19 showed a negative impact on patients with MDR-GN BSIs admitted to the ICU.
