Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared
Abstract
:1. Introduction
2. Results
2.1. Microbiological Data
2.2. Hospitalization and Mortality Data
3. Discussion
4. Materials and Methods
4.1. Definitions
4.2. Microbiological Analyses
Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | Total Population | No-CoV | CoV | p Value |
---|---|---|---|---|
(n 46) | (n 28) | (n 18) | ||
General, n, % | ||||
Age, years, median (IQR) | 65.5 (57–73) | 66.5 (56.7–73) | 63.5 (57.5–72.5) | ns |
Gender, F/M | 14 (30.4)/32 (69.6) | 11 (39.3)/17 (60.7) | 3 (16.7)/15 (83.3) | ns |
Other hospitalization in previous 90 days | 10 (21.7) | 8 (22.8) | 2 (10.5) | ns |
Pre-hospitalization antibiotic therapy in previous 90 days | 13 (28.3) | 6 (20.4) | 7 (36.8) | ns |
Pre-BSI antibiotic therapy | 45 (97.8) | 27 (95.4) | 18 (100) | ns |
Patients with >1 BSI from different MDRO | 14 (30.4) | 13 (28.3) | 1 (2.2) | 0.003 |
Comorbidities, n. (%) | ||||
Myocardial infarction | 7 (15.2) | 5 (17.9) | 2 (11.1) | ns |
Congestive heart failure | 14 (30.4) | 10 (35.7) | 4 (22.2) | ns |
Peripheral vascular disease | 13 (28.3) | 8 (28.6) | 5 (27.8) | ns |
Cerebrovascular disease | 4 (8.7) | 3 (10.7) | 1 (5.5) | ns |
Dementia | 3 (6.5) | 2 (7.1) | 1 (5.5) | ns |
Chronic obstructive pulmonary disease | 6 (13) | 6 (21.4) | 0 | NA |
Liver disease {1} | 1 (2.2) | 1 (3.6) | 0 | NA |
Diabetes mellitus | 11 (23.9) | 8 (28.6) | 3 (7.2) | ns |
Hemiplegia | 1 (2.2) | 1 (3.6) | 0 | NA |
Chronic kidney disease {2} | 2 (4.4) | 1 (3.6) | 1 (5.5) | ns |
Solid tumor | 3 (6.5) | 3 (10.7) | 0 | NA |
Leukemia | 1 (2.2) | 0 | 1 (5.5) | NA |
Charlson Comorbidity Index, median (IQR) | 3.5 (2–6) | 4 (2–6) | 2 (1.25–4) | ns |
APACHE II score {3}, median (IQR) | 18.5 (13–23) | 22 (16–23) | 11 (3.2–21.5) | 0.003 |
Polytrauma | 9 (19.6) | 9 (32.1) | 0 (0) | 0.007 |
Outcome, median (IQR) | ||||
Days of hospitalization overall | 43 (29.5–98.75) | 69.5 (43.5–141.5) | 28.5(18.7–35.7) | 0.001 |
Days of hospitalization until ICU admission | 2 (0–6) | 2 (0–9.75) | 2 (0.25–5) | ns |
Days of hospitalization until BSI | 25.5 (12.25–37.5) | 29 (15–48.25) | 20 (9.5–26.75) | 0.02 |
Days of ICU hospitalization | 31.5 (21.25–68) | 56 (28–91.25) | 25 (13.5–29.5) | 0.004 |
Days of ICU hospitalization until BSI | 18.5 (9–29) | 23 (9.75–34.75) | 14.5 (9–21.75) | ns |
Days of hospitalization from BSI to death | 15.5 (4.25–45.75) | 44 (14.5–117.5) | 5 (1.25–11.75) | 0.003 |
Overall in-hospital mortality, n. (%) | 29 (63) | 15 (53.6) | 14 (77.8) | ns |
Mortality 30 days from ICU admission, n. (%) | 20 (43.5) | 6 (21.4) | 14 (77.8) | <0.0001 |
Mortality 30 days from BSI, n. (%) | 20 (43.5) | 6 (21.4) | 14 (77.8) | <0.0001 |
BSI Characteristics | Total BSI | No-CoV | CoV | |
(n 63) | (n 44) | (n 19) | ||
Microbiological data, n (%) | ||||
Pre-BSI infections from no MDRO {4} | 57 (90.6) | 43 (97.7%) | 14 (73.7) | 0.003 |
Pre-BSI infections from MDRO {4} | 48 (76.2) | 38 (86.4) | 10 (52.6) | 0.004 |
MDRO colonization | 45 (71.4) | 36 (81.8) | 9 (47.4) | 0.005 |
Overall BSI incidence density, n per 100 patients | 16.5 | 11.2 | ns | |
K. pneumoniae BSI | 26 (41.3) | 22 (50) | 4 (21) | 0.032 |
-Incidence density, n per 100 patients | 8.2 | 2.4 | 0.012 | |
A. baumannii BSI | 32 (50.8) | 17 (38.6) | 15 (78.9) | 0.003 |
-Incidence density, n per 100 patients | 6.4 | 9 | ns | |
P. aeruginosa BSI | 5 (7.9) | 5 (11.4) | 0 | ns |
Source of BSI | ns | |||
| 31 (49.2) | 21 (47.7) | 10 (52.6) | |
| 5 (7.9) | 5 (11.4) | 0 | |
| 2 (3.2) | 2 (4.5) | 0 | |
Primary BSI | 25 (39.7) | 16 (36.4) | 9 (47.4) | ns |
Source control | 8 (12.7) | 4 (9.1) | 4 (21) | ns |
Clinical data | ||||
Septic shock at BSI onset, n (%) | 25 (39.7) | 12 (27.3) | 13 (68.4) | 0.003 |
PITT score on the BSI day, median (IQR) | 3 (1–8) | 3 (1–5) | 8 (2–8) | 0.002 |
Treatment data | ||||
Early active therapy (<24 h), n (%) | 31 (49.2) | 21 (47.7) | 10 (52.6) | ns |
Time to definite therapy, median (IQR) | 1 (1–2) | 1 (1–2) | 1 (1–2) | ns |
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Cogliati Dezza, F.; Arcari, G.; Alessi, F.; Valeri, S.; Curtolo, A.; Sacco, F.; Ceccarelli, G.; Raponi, G.; Alessandri, F.; Mastroianni, C.M.; et al. Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared. Antibiotics 2022, 11, 926. https://doi.org/10.3390/antibiotics11070926
Cogliati Dezza F, Arcari G, Alessi F, Valeri S, Curtolo A, Sacco F, Ceccarelli G, Raponi G, Alessandri F, Mastroianni CM, et al. Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared. Antibiotics. 2022; 11(7):926. https://doi.org/10.3390/antibiotics11070926
Chicago/Turabian StyleCogliati Dezza, Francesco, Gabriele Arcari, Federica Alessi, Serena Valeri, Ambrogio Curtolo, Federica Sacco, Giancarlo Ceccarelli, Giammarco Raponi, Francesco Alessandri, Claudio Maria Mastroianni, and et al. 2022. "Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared" Antibiotics 11, no. 7: 926. https://doi.org/10.3390/antibiotics11070926
APA StyleCogliati Dezza, F., Arcari, G., Alessi, F., Valeri, S., Curtolo, A., Sacco, F., Ceccarelli, G., Raponi, G., Alessandri, F., Mastroianni, C. M., Venditti, M., & Oliva, A. (2022). Clinical Impact of COVID-19 on Multi-Drug-Resistant Gram-Negative Bacilli Bloodstream Infections in an Intensive Care Unit Setting: Two Pandemics Compared. Antibiotics, 11(7), 926. https://doi.org/10.3390/antibiotics11070926