학술논문
The Burden of Carbapenem-Resistant Acinetobacter baumannii in ICU COVID-19 Patients: A Regional Experience
Document Type
article
Author
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, Vol 11, Iss 17, p 5208 (2022)
Subject
Language
English
ISSN
2077-0383
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.