e-Article
Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)
Document Type
article
Author
Monica Monaco; Marco Floridia; Marina Giuliano; Luigi Palmieri; Cinzia Lo Noce; Annalisa Pantosti; Anna Teresa Palamara; Silvio Brusaferro; Graziano Onder; The Italian National Institute of Health COVID-19 Mortality Group; Elvira Agazio; Pierfrancesco Barbariol; Antonino Bella; Eva Benelli; Luigi Bertinato; Matilde Bocci; Stefano Boros; Marco Bressi; Giovanni Calcagnini; Federica Censi; Alessandra Ciervo; Elisa Colaizzo; Cecilia Damiano; Martina Del Manso; Corrado Di Benedetto; Chiara Donfrancesco; Massimo Fabiani; Francesco Facchiano; Fabio Galati; Tiziana Grisetti; Cecilia Guastadisegni; Pietro Maiozzi; Valerio Manno; Margherita Martini; Alberto Mateo Urdiales; Eugenio Mattei; Claudia Meduri; Paola Meli; Giada Minelli; Daniele Petrone; Patrizio Pezzotti; Flavia Pricci; Ornella Punzo; Flavia Riccardo; Chiara Sacco; Paolo Salerno; Debora Serra; Matteo Spuri; Marco Tallon; Manuela Tamburo De Bella; Dorina Tiple; Brigid Unim; Luana Vaianella; Maria Fenicia Vescio; Liliana Elena Weimer
Source
Frontiers in Medicine, Vol 9 (2022)
Subject
Language
English
ISSN
2296-858X
Abstract
IntroductionIn hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance.MethodsHospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses.ResultsThe study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018).ConclusionsIn patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.