1. The Burden of Carbapenem-Resistant Acinetobacter baumannii in ICU COVID-19 Patients: A Regional Experience
- Author
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Giorgia Montrucchio, Silvia Corcione, Tommaso Lupia, Nour Shbaklo, Carlo Olivieri, Miriam Poggioli, Aline Pagni, Davide Colombo, Agostino Roasio, Stefano Bosso, Fabrizio Racca, Valeria Bonato, Francesco Della Corte, Stefania Guido, Andrea Della Selva, Enrico Ravera, Nicoletta Barzaghi, Martina Cerrano, Pietro Caironi, Giacomo Berta, Cecilia Casalini, Bruno Scapino, Michele Grio, Massimiliano Parlanti Garbero, Gabriella Buono, Federico Finessi, Simona Erbetta, Paola Federica Sciacca, Gilberto Fiore, Alessandro Cerutti, Sergio Livigni, Daniela Silengo, Fulvio Agostini, Maurizio Berardino, Mauro Navarra, Silvia Vendramin, Enzo Castenetto, Marco Maria Liccardi, Emilpaolo Manno, Luca Brazzi, and Francesco Giuseppe De Rosa
- Subjects
Acinetobacter baumannii ,critical care ,Acinetobacter infections ,COVID-19 ,SARS-CoV-2 ,antimicrobial drug resistance ,carbapenems ,intensive care unit ,multidrug resistance ,nosocomial infections ,General Medicine - Abstract
Since the beginning of the COVID-19 pandemic, the impact of superinfections in intensive care units (ICUs) has progressively increased, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab). This observational, multicenter, retrospective study was designed to investigate the characteristics of COVID-19 ICU patients developing CR-Ab colonization/infection during an ICU stay and evaluate mortality risk factors in a regional ICU network. A total of 913 COVID-19 patients were admitted to the participating ICUs; 19% became positive for CR-Ab, either colonization or infection (n = 176). The ICU mortality rate in CR-Ab patients was 64.7%. On average, patients developed colonization or infection within 10 ± 8.4 days from ICU admission. Scores of SAPS II and SOFA were significantly higher in the deceased patients (43.8 ± 13.5, p = 0.006 and 9.5 ± 3.6, p < 0.001, respectively). The mortality rate was significantly higher in patients with extracorporeal membrane oxygenation (12; 7%, p = 0.03), septic shock (61; 35%, p < 0.001), and in elders (66 ± 10, p < 0.001). Among the 176 patients, 129 (73%) had invasive infection with CR-Ab: 105 (60.7%) Ventilator-Associated Pneumonia (VAP), and 46 (26.6%) Bloodstream Infections (BSIs). In 22 cases (6.5%), VAP was associated with concomitant BSI. Colonization was reported in 165 patients (93.7%). Mortality was significantly higher in patients with VAP (p = 0.009). Colonized patients who did not develop invasive infections had a higher survival rate (p < 0.001). Being colonized by CR-Ab was associated with a higher risk of developing invasive infections (p < 0.001). In a multivariate analysis, risk factors significantly associated with mortality were age (OR = 1.070; 95% CI (1.028–1.115) p = 0.001) and CR-Ab colonization (OR = 5.463 IC95% 1.572–18.988, p = 0.008). Constant infection-control measures are necessary to stop the spread of A. baumannii in the hospital environment, especially at this time of the SARS-CoV-2 pandemic, with active surveillance cultures and the efficient performance of a multidisciplinary team.
- Published
- 2022
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