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Montrucchio G, Corcione S, Lupia T, Shbaklo N, Olivieri C, Poggioli M, Pagni A, Colombo D, Roasio A, Bosso S, Racca F, Bonato V, Della Corte F, Guido S, Della Selva A, Ravera E, Barzaghi N, Cerrano M, Caironi P, Berta G, Casalini C, Scapino B, Grio M, Parlanti Garbero M, Buono G, Finessi F, Erbetta S, Sciacca PF, Fiore G, Cerutti A, Livigni S, Silengo D, Agostini F, Berardino M, Navarra M, Vendramin S, Castenetto E, Liccardi MM, Manno E, Brazzi L, De Rosa FG. The Burden of Carbapenem-Resistant Acinetobacter baumannii in ICU COVID-19 Patients: A Regional Experience. J Clin Med 2022; 11:jcm11175208. [PMID: 36079137 PMCID: PMC9456723 DOI: 10.3390/jcm11175208] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 12/04/2022] Open
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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Affiliation(s)
- Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Department of Anaesthesia, Critical Care and Emergency—Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy
- Correspondence:
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- Division of Geographic Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Carlo Olivieri
- S.C. Anestesia e Rianimazione, Ospedale Sant’Andrea, 13100 Vercelli, Italy
| | - Miriam Poggioli
- S.C. Anestesia e Rianimazione, Ospedale Sant’Andrea, 13100 Vercelli, Italy
| | - Aline Pagni
- S.C. Anestesia e Rianimazione, Ospedale SS. Trinità—Borgomanero—ASL NO, 28021 Borgomanero, Italy
| | - Davide Colombo
- S.C. Anestesia e Rianimazione, Ospedale SS. Trinità—Borgomanero—ASL NO, 28021 Borgomanero, Italy
| | - Agostino Roasio
- S.C. Anestesia e Rianimazione, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Stefano Bosso
- S.C. Anestesia e Rianimazione, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Fabrizio Racca
- S.C. Anestesia e Rianimazione, Ospedale SS. Arrigo e Biagio, 15121 Alessandria, Italy
| | - Valeria Bonato
- S.C. Anestesia e Rianimazione, Ospedale SS. Arrigo e Biagio, 15121 Alessandria, Italy
| | - Francesco Della Corte
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont—UPO, 28100 Novara, Italy
| | - Stefania Guido
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont—UPO, 28100 Novara, Italy
| | | | - Enrico Ravera
- S.C. Anestesia e Rianimazione, ASL CN2, 12060 Verduno, Italy
| | - Nicoletta Barzaghi
- Dipartimento di Emergenza ed Aree Critiche, SSD Rianimazione, A.S.O.S. Croce e Carle, 12100 Cuneo, Italy
| | - Martina Cerrano
- Dipartimento di Emergenza ed Aree Critiche, SSD Rianimazione, A.S.O.S. Croce e Carle, 12100 Cuneo, Italy
| | - Pietro Caironi
- S.C.DU Anestesia e Rianimazione, AOU S. Luigi Gonzaga, Dipartimento di Oncologia, Università degli Studi di Torino, 10043 Orbassano, Italy
| | - Giacomo Berta
- S.C.DU Anestesia e Rianimazione, AOU S. Luigi Gonzaga, Dipartimento di Oncologia, Università degli Studi di Torino, 10043 Orbassano, Italy
| | - Cecilia Casalini
- S.C. Anestesia e Rianimazione, Ospedale di Ivrea, ASL TO4, 10015 Ivrea, Italy
| | - Bruno Scapino
- S.C. Anestesia e Rianimazione, Ospedale di Ivrea, ASL TO4, 10015 Ivrea, Italy
| | - Michele Grio
- S.C. Anestesia e Rianimazione, Ospedale di Rivoli, 10098 Rivoli, Italy
| | | | - Gabriella Buono
- S.C. Rianimazione Generale, AO Ordine Mauriziano, 10128 Turin, Italy
| | - Federico Finessi
- S.C. Rianimazione Generale, AO Ordine Mauriziano, 10128 Turin, Italy
| | - Simona Erbetta
- S.C. Anestesia e Rianimazione Moncalieri-Carmagnola, ASL TO5, 10023 Chieri, Italy
| | | | - Gilberto Fiore
- S.C. Anestesia e Rianimazione Moncalieri-Carmagnola, ASL TO5, 10023 Chieri, Italy
| | - Alessandro Cerutti
- S.C. Anestesia e Rianimazione Moncalieri-Carmagnola, ASL TO5, 10023 Chieri, Italy
| | - Sergio Livigni
- S.C Anestesia e Rianimazione Ospedale S. Giovanni Bosco, ASL Città di Torino, 10144 Turin, Italy
| | - Daniela Silengo
- S.C Anestesia e Rianimazione Ospedale S. Giovanni Bosco, ASL Città di Torino, 10144 Turin, Italy
| | - Fulvio Agostini
- S.C. Anestesia e Rianimazione, Presidio CTO, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Maurizio Berardino
- S.C. Anestesia e Rianimazione, Presidio CTO, AOU Città della Salute e della Scienza, 10126 Turin, Italy
| | - Mauro Navarra
- S.C. Anestesia e Rianimazione, Ospedale Martini, ASL Città di Torino, 10149 Turin, Italy
| | - Silvia Vendramin
- S.C. Anestesia e Rianimazione, Ospedale Martini, ASL Città di Torino, 10149 Turin, Italy
| | - Enzo Castenetto
- S.C. Anestesia e Rianimazione, Ospedale di Chivasso, ASL TO4, 10034 Chivasso, Italy
| | - Marco Maria Liccardi
- S.C. Anestesia e Rianimazione, Ospedale di Chivasso, ASL TO4, 10034 Chivasso, Italy
| | - Emilpaolo Manno
- S.C. Anestesia e Rianimazione, Ospedale Maria Vittoria, ASL Città di Torino, 10144 Turin, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Department of Anaesthesia, Critical Care and Emergency—Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy
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