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.

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

Montrucchio, Giorgia;Corcione, Silvia;Lupia, Tommaso;Shbaklo, Nour;Roasio, Agostino;Bosso, Stefano;Della Selva, Andrea;Cerrano, Martina;Caironi, Pietro;Berta, Giacomo;Parlanti Garbero, Massimiliano;Finessi, Federico;Erbetta, Simona;Sciacca, Paola Federica;Silengo, Daniela;Berardino, Maurizio;Navarra, Mauro;Vendramin, Silvia;Liccardi, Marco Maria;Brazzi, Luca;De Rosa, Francesco Giuseppe
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.
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Acinetobacter baumannii; Acinetobacter infections; COVID-19; SARS-CoV-2; antimicrobial drug resistance; carbapenems; critical care; intensive care unit; multidrug resistance; nosocomial infections
Montrucchio, Giorgia; Corcione, Silvia; Lupia, Tommaso; Shbaklo, Nour; Olivieri, Carlo; Poggioli, Miriam; Pagni, Aline; Colombo, Davide; Roasio, Agostino; Bosso, Stefano; Racca, Fabrizio; Bonato, Valeria; Della Corte, Francesco; Guido, Stefania; Della Selva, Andrea; Ravera, Enrico; Barzaghi, Nicoletta; Cerrano, Martina; Caironi, Pietro; Berta, Giacomo; Casalini, Cecilia; Scapino, Bruno; Grio, Michele; Parlanti Garbero, Massimiliano; Buono, Gabriella; Finessi, Federico; Erbetta, Simona; Sciacca, Paola Federica; Fiore, Gilberto; Cerutti, Alessandro; Livigni, Sergio; Silengo, Daniela; Agostini, Fulvio; Berardino, Maurizio; Navarra, Mauro; Vendramin, Silvia; Castenetto, Enzo; Liccardi, Marco Maria; Manno, Emilpaolo; Brazzi, Luca; De Rosa, Francesco Giuseppe
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1873818
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