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The Burden of Carbapenem-Resistant Acinetobacter baumannii in ICU COVID-19 Patients: A Regional Experience

Authors :
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
Francesco Giuseppe De Rosa
Source :
Journal of Clinical Medicine; Volume 11; Issue 17; Pages: 5208
Publication Year :
2022
Publisher :
Multidisciplinary Digital Publishing Institute, 2022.

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.

Details

Language :
English
ISSN :
20770383
Database :
OpenAIRE
Journal :
Journal of Clinical Medicine; Volume 11; Issue 17; Pages: 5208
Accession number :
edsair.doi.dedup.....6b40a1d3594597356c793187b0bf6696
Full Text :
https://doi.org/10.3390/jcm11175208