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Ntziora F, Giannitsioti E. Bloodstream infections in the era of the COVID-19 pandemic: Changing epidemiology of antimicrobial resistance in the intensive care unit. JOURNAL OF INTENSIVE MEDICINE 2024; 4:269-280. [PMID: 39035613 PMCID: PMC11258508 DOI: 10.1016/j.jointm.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 07/23/2024]
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic increased the burden of critically ill patients who required hospitalization in the intensive care unit (ICU). Bacterial and fungal co-infections, including bloodstream infections (BSIs), increased significantly in ICU patients with COVID-19; this had a significant negative impact on patient outcomes. Reported data pertaining to BSI episodes from the ICU setting during the COVID-19 pandemic were collected and analyzed for this narrative review. We searched the PubMed database for articles published between March 2020 and October 2023; the terms "COVID-19" AND "bloodstream infections" AND "ICU" were used for the search. A total of 778 articles were retrieved; however, only 27 were exclusively related to BSIs in ICU patients with COVID-19. Data pertaining to the epidemiological characteristics, risk factors, characteristics of bacterial and fungal BSIs, patterns of antimicrobial resistance, and comparisons between ICU and non-ICU patients during and before the COVID-19 pandemic were obtained. Data on antimicrobial stewardship and infection-control policies were also included. The rates of BSI were found to have increased among ICU patients with COVID-19 than in non-COVID-19 patients and those admitted during the pre-pandemic period. Male gender, 60-70 years of age, increased body mass index, high Sequential Organ Failure Assessment scores at admission, prolonged hospital and ICU stay, use of central lines, invasive ventilation, and receipt of extracorporeal membrane oxygenation were all defined as risk factors for BSI. The use of immune modulators for COVID-19 appeared to increase the risk of BSI; however, the available data are conflicting. Overall, Enterococci, Acinetobacter baumannii, and Candida spp. emerged as prominent infecting organisms during the pandemic; along with Enterobacterales and Pseudomonas aeruginosa they had a significant impact on mortality. Multidrug-resistant organisms prevailed in the ICU, especially if antimicrobial resistance was established before the COVID-19 pandemic and were significantly associated with increased mortality rates. The unnecessary and widespread use of antibiotics further increased the prevalence of multidrug-resistant organisms during COVID-19. Notably, the data indicated a significant increase in contaminants in blood cultures; this highlighted the decline in compliance with infection-control measures, especially during the initial waves of the pandemic. The implementation of infection-control policies along with antibiotic stewardship succeeded in significantly reducing the rates of blood contamination and BSI pathogens. BSIs considerably worsened outcomes in patients with COVID-19 who were admitted to ICUs. Further studies are needed to evaluate adequate preventive and control measures that may increase preparedness for the future.
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Affiliation(s)
- Fotinie Ntziora
- 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- 1st Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Doubravská L, Htoutou Sedláková M, Fišerová K, Klementová O, Turek R, Langová K, Kolář M. Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study. Antibiotics (Basel) 2024; 13:192. [PMID: 38391578 PMCID: PMC10886267 DOI: 10.3390/antibiotics13020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).
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Affiliation(s)
- Lenka Doubravská
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Miroslava Htoutou Sedláková
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Fišerová
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Olga Klementová
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Radovan Turek
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Milan Kolář
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
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Alessandri F, d'Ettorre G, Ciccozzi M, Migliara G, Baccolini V, Pugliese F, Ceccarelli G. Early recognition of a superinfection: This is the problem in the critically ill COVID-19 patients. J Med Virol 2024; 96:e29345. [PMID: 38148715 DOI: 10.1002/jmv.29345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Francesco Alessandri
- Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Department of Infection Disease, Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Pugliese
- Department of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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De Francesco MA, Piva S, Pellizzeri S, Signorini L, Fumarola B, Corbellini S, Piccinelli G, Simonetti F, Carta V, Mangeri L, Padovani M, Vecchiati D, Latronico N, Castelli F, Caruso A. Response to the Letter to the Editor on "Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS-CoV-2 infection than negative patients and are associated to a worse outcome". J Med Virol 2023; 95:e29192. [PMID: 37855669 DOI: 10.1002/jmv.29192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Maria Antonia De Francesco
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Universita degli Studi di Brescia Dipartimento Specialita Medico-Chirurgiche Scienze Radiologiche e Sanita Pubblica, Brescia, Italy
| | - Simone Pellizzeri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Liana Signorini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Benedetta Fumarola
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Francesca Simonetti
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Valentina Carta
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Lucia Mangeri
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Michela Padovani
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Daniela Vecchiati
- First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, Universita degli Studi di Brescia Dipartimento Specialita Medico-Chirurgiche Scienze Radiologiche e Sanita Pubblica, Brescia, Italy
| | - Francesco Castelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Arnaldo Caruso
- Department of Molecular and Translational Medicine, Institute of Microbiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
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Abbasi HQ. Comments on: Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS CoV-2 infection than negative patients and are associated to a worse outcome. J Med Virol 2023; 95:e29167. [PMID: 37812036 DOI: 10.1002/jmv.29167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
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Fiorini AC, de Almeida ACG, Scorza FA, Finsterer J. Inflammatory markers as outcome predictors of COVID-19 in pregnant women. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230870. [PMID: 37792873 PMCID: PMC10547484 DOI: 10.1590/1806-9282.20230870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Ana Claudia Fiorini
- Pontifícia Universidade Católica de São Paulo, Programa de Estudos Pós-Graduado em Fonoaudiologia – São Paulo (SP), Brazil
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fonoaudiologia – São Paulo (SP), Brazil
| | - Antonio-Carlos Giomaraes de Almeida
- Universidade Federal de São Paulo, Centro de Neurociências e Saúde da Mulher “Professor Geraldo Rodrigues de Lima.”, Escola Paulista de Medicina – São Paulo (SP), Brazil
| | - Fulvio Alexandre Scorza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Neurociência – São Paulo (SP), Brazil
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