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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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Boni S, Sartini M, Del Puente F, Adriano G, Blasi Vacca E, Bobbio N, Carbone A, Feasi M, Grasso V, Lattuada M, Nelli M, Oliva M, Parisini A, Prinapori R, Santarsiero MC, Tigano S, Cristina ML, Pontali E. Innovative Approaches to Monitor Central Line Associated Bloodstream Infections (CLABSIs) Bundle Efficacy in Intensive Care Unit (ICU): Role of Device Standardized Infection Rate (dSIR) and Standardized Utilization Ratio (SUR)-An Italian Experience. J Clin Med 2024; 13:396. [PMID: 38256530 PMCID: PMC10816537 DOI: 10.3390/jcm13020396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
In several settings, the COVID-19 pandemic determined a negative impact on the occurrence of healthcare-associated infection, particularly for on central lines associated bloodstream infections (CLABSI). In our setting, we observed a significant increase in CLABSI in our intensive care unit (ICU) during 2020 and 2021 vs. 2018 to 2019. A refresher training activity on central venous catheter (CVC) management bundles was carried out in September-October 2021 for the ICU health staff. We assessed the impact of bundle implementation by means of standardized indicators, such as the Device Utilization Ratio (DUR), in this case, the Central Line Utilization Ratio, the Standardized Utilization Ratio (SUR), and the device Standardized Infection Ratio (dSIR). Standardized ratios for device use and infection ratio were computed using data from 2018 and 2019 as expectation data. After bundle implementation, we observed a significant reduction of dSIR (p < 0.001), which dropped from 3.23 and 2.99 in the 2020-2021 biennium to 1.11 in 2022 (CLABSI in the first quarter only); no more CLABSI were observed afterwards. Standardized ratios proved helpful in identify increasing trends of CLABSI in the ICU and monitoring the impact of a simple effective tool, i.e., training on and implementation of a bundle for CVC management.
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Affiliation(s)
- Silvia Boni
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Marina Sartini
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Filippo Del Puente
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Giulia Adriano
- Hospital Infection Control Committee, Galliera Hospital, 16128 Genoa, Italy; (G.A.); (M.C.S.)
| | - Elisabetta Blasi Vacca
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Nicoletta Bobbio
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Alessio Carbone
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Viviana Grasso
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (V.G.); (M.L.)
| | - Marco Lattuada
- Anaesthesia and Intensive Care Unit, E.O. Ospedali Galliera, 16128 Genoa, Italy; (V.G.); (M.L.)
| | - Mauro Nelli
- Medical Service Management, Galliera Hospital, 16128 Genoa, Italy;
| | - Martino Oliva
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
| | - Andrea Parisini
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Roberta Prinapori
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | | | - Stefania Tigano
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
| | - Maria Luisa Cristina
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
| | - Emanuele Pontali
- Department of Infectious Diseases, Galliera Hospital, 16128 Genoa, Italy; (S.B.); (F.D.P.); (E.B.V.); (N.B.); (M.F.); (A.P.); (R.P.); (S.T.)
- Operating Unit Hospital Hygiene, Galliera Hospital, 16128 Genoa, Italy; (M.S.); (A.C.); (M.O.); (M.L.C.)
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Papic I, Bistrovic P, Cikara T, Busic N, Keres T, Ortner Hadziabdic M, Lucijanic M. Corticosteroid Dosing Level, Incidence and Profile of Bacterial Blood Stream Infections in Hospitalized COVID-19 Patients. Viruses 2024; 16:86. [PMID: 38257786 PMCID: PMC10820464 DOI: 10.3390/v16010086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
COVID-19 patients with severe or critical symptoms are often treated with corticosteroids, per contemporary guidelines. Due to their immunosuppressive and immunomodulatory properties, corticosteroids are associated with the development of superinfections. We aimed to retrospectively assess patterns of corticosteroid use and the profiles of bacterial blood stream infections associated with exposure to different dosing levels, in a cohort of 1558 real-life adult COVID-19 patients. A total of 1391 (89.3%) patients were treated with corticosteroids, with 710 (45.6%) patients receiving low, 539 (34.6%) high and 142 (9.1%) very high corticosteroid doses. Bacteremia developed in a total of 178 (11.4%) patients. The risk of bacteremia was of similar magnitude between the no and low-dose corticosteroid treatments (p = 0.352), whereas it progressively increased with high (OR 6.18, 95% CI (2.66-14.38), p < 0.001) and very high corticosteroid doses (OR 8.12, 95% CI (3.29-20.05), p < 0.001), compared to no corticosteroid treatment. These associations persisted after multivariate adjustments and were present independently of sex, comorbidity burden, and mechanical ventilation. The profiles of individual bacterial pathogens differed depending on the used corticosteroid doses. High and very high corticosteroid doses are frequently used for real-life COVID-19 patients with severe and critical clinical presentations and are associated with a higher risk of bacteremia independently of sex, comorbidity burden, and mechanical ventilation use.
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Affiliation(s)
- Ivan Papic
- Pharmacy Department, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Petra Bistrovic
- Cardiology Department, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Tomislav Cikara
- Cardiology Department, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Nikolina Busic
- Department of Internal Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Tatjana Keres
- Department of Internal Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Maja Ortner Hadziabdic
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, 10000 Zagreb, Croatia
| | - Marko Lucijanic
- Hematology Department, University Hospital Dubrava, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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