tetano
Editor, Senior Moderator
BMC Infect Dis
. 2021 Sep 8;21(1):933.
doi: 10.1186/s12879-021-06647-x.
Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study
Naveenraj Palanisamy[SUP] 1 [/SUP], Nakka Vihari[SUP] 1 [/SUP], Durga Shankar Meena[SUP] 2 [/SUP], Deepak Kumar[SUP] 1 [/SUP], Naresh Midha[SUP] 1 [/SUP], Vibhor Tak[SUP] 3 [/SUP], Ankur Sharma[SUP] 4 [/SUP], Gopal Krishana Bohra[SUP] 1 [/SUP], Nikhil Kothari[SUP] 4 [/SUP], Naveen Dutt[SUP] 5 [/SUP], Pradeep Kumar Bhatia[SUP] 4 [/SUP], Mahendra Kumar Garg[SUP] 1 [/SUP], Sanjeev Misra[SUP] 6 [/SUP]
Affiliations
Abstract
Background: Bloodstream infections (BSIs) are an emerging cause of significant morbidity and mortality in severe Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill COVID-19 patients.
Methods: This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age > 18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 admitted in the intensive care unit (ICU) were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs.
Results: Out of 750 patients admitted in COVID ICU, 8.5% developed secondary BSIs. All severe COVID-19 patients who developed BSIs succumbed to illness. A significant proportion of BSIs were Gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate, followed by Klebsiella pneumoniae (32.8% and 21.9%, respectively). Multidrug-resistance organisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of Gram-negative bacteria resistant to carbapenems was 47.2% (25/53). On multivariate analysis, raised total leukocyte counts, mechanical ventilation and presence of comorbidities were significantly associated with the incidence of BSIs.
Conclusion: We found a significant prevalence of Acinetobacter baumannii in COVID-19 associated BSIs. The presence of comorbidities raised leukocyte counts and mechanical ventilation should alarm clinicians for possible BSIs. The timely initiation of empirical antibiotics and rapid de-escalation is vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.
Keywords: Acinetobacter baumannii; Antimicrobial resistance; BSIs; COVID-19; ICU; Pneumonia.
. 2021 Sep 8;21(1):933.
doi: 10.1186/s12879-021-06647-x.
Clinical profile of bloodstream infections in COVID-19 patients: a retrospective cohort study
Naveenraj Palanisamy[SUP] 1 [/SUP], Nakka Vihari[SUP] 1 [/SUP], Durga Shankar Meena[SUP] 2 [/SUP], Deepak Kumar[SUP] 1 [/SUP], Naresh Midha[SUP] 1 [/SUP], Vibhor Tak[SUP] 3 [/SUP], Ankur Sharma[SUP] 4 [/SUP], Gopal Krishana Bohra[SUP] 1 [/SUP], Nikhil Kothari[SUP] 4 [/SUP], Naveen Dutt[SUP] 5 [/SUP], Pradeep Kumar Bhatia[SUP] 4 [/SUP], Mahendra Kumar Garg[SUP] 1 [/SUP], Sanjeev Misra[SUP] 6 [/SUP]
Affiliations
- PMID: 34496787
- DOI: 10.1186/s12879-021-06647-x
Abstract
Background: Bloodstream infections (BSIs) are an emerging cause of significant morbidity and mortality in severe Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence, clinical profile and outcome of BSIs in critically ill COVID-19 patients.
Methods: This was a single-centre retrospective study conducted at a tertiary care hospital in Western India. All patients (age > 18 years) with reverse-transcription polymerase chain reaction (RT-PCR) confirmed COVID-19 admitted in the intensive care unit (ICU) were included. Hospital electronic records were searched for demographic data, time of bloodstream infection since admission, clinical profile, antimicrobial resistance pattern and clinical outcome of all patients who developed BSIs.
Results: Out of 750 patients admitted in COVID ICU, 8.5% developed secondary BSIs. All severe COVID-19 patients who developed BSIs succumbed to illness. A significant proportion of BSIs were Gram-negative pathogens (53/64, 82.8%). Acinetobacter baumannii was the commonest isolate, followed by Klebsiella pneumoniae (32.8% and 21.9%, respectively). Multidrug-resistance organisms (MDRO) were found in 57.8% of the cases. The majority of MDRO belonged to K. pneumoniae and Enterococcus groups. The proportion of Gram-negative bacteria resistant to carbapenems was 47.2% (25/53). On multivariate analysis, raised total leukocyte counts, mechanical ventilation and presence of comorbidities were significantly associated with the incidence of BSIs.
Conclusion: We found a significant prevalence of Acinetobacter baumannii in COVID-19 associated BSIs. The presence of comorbidities raised leukocyte counts and mechanical ventilation should alarm clinicians for possible BSIs. The timely initiation of empirical antibiotics and rapid de-escalation is vital to improve the outcome. At the same time, strict compliance of infection control practices should be accomplished to reduce the occurrence of MDRO.
Keywords: Acinetobacter baumannii; Antimicrobial resistance; BSIs; COVID-19; ICU; Pneumonia.