Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy.
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Viale dell'Università 37, 00161, Rome, Italy.
Infection. 2022 Feb;50(1):83-92. doi: 10.1007/s15010-021-01643-4. Epub 2021 Jun 27.
Superinfections in patients hospitalized in intensive care unit (ICU) are an important and challenging complication, also in COVID-19. However, no definitive data are available about the role of multidrug-resistant Acinetobacter baumannii (MDR-AB) in COVID-19.
This was a single-center, cross-sectional study including patients with MDR-AB infections admitted to ICU with or without COVID-19, between January 2019 and January 2021. The primary objective of the study was to evaluate risk factor for MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology. The secondary endpoints were 30-days mortality in all study population and risk factors associated with development of bloodstream infection (BSI).
During the study period 32 adults with COVID-19 were enrolled and compared with 115 patients admitted in the same ICU for other reasons. We observed a total of 114 deaths, with a survival rate of 29.3%: 18.8% in COVID-19 and 32.2% in control group. Relative risk for MDR-AB infection in COVID-19 showed that serum lactate levels mmol/l > 2, Acinetobacter baumannii colonization, BSI and steroid therapy were observed more frequently in COVID-19 patients. Cox regression analysis showed that serum lactate levels > 2 mmol/l, Acinetobacter baumannii colonization, BSI, and steroid therapy were associated with 30-days mortality. Finally, patients with COVID-19, white blood cells count > 11,000 mm, serum lactate levels > 2 mmol/l, infections at time of ICU admission, Acinetobacter baumannii colonization, and steroid therapy were independently associated with development of BSI.
Our data highlight the impact of BSI on outcome, the role of Acinetobacter baumannii colonization and the use of steroids on the risk to develop MDR-AB infections also during COVID-19.
重症监护病房（ICU）住院患者的合并感染是一个重要且具有挑战性的并发症，在 COVID-19 患者中也是如此。然而，目前尚无关于多药耐药鲍曼不动杆菌（MDR-AB）在 COVID-19 中作用的确切数据。
这是一项单中心、横断面研究，纳入 2019 年 1 月至 2021 年 1 月期间 ICU 中收治的患有 MDR-AB 感染的患者，无论是否患有 COVID-19。该研究的主要目的是评估 COVID-19 或其他病因住院 ICU 患者发生 MDR-AB 感染的危险因素。次要终点是所有研究人群的 30 天死亡率和与血流感染（BSI）发生相关的危险因素。
在研究期间，共纳入 32 例 COVID-19 成人患者，并与同期 ICU 中因其他原因入院的 115 例患者进行比较。我们共观察到 114 例死亡，生存率为 29.3%：COVID-19 患者为 18.8%，对照组为 32.2%。COVID-19 患者发生 MDR-AB 感染的相对风险显示，血清乳酸水平 mmol/L>2、鲍曼不动杆菌定植、BSI 和类固醇治疗更为常见。Cox 回归分析显示，血清乳酸水平>2mmol/L、鲍曼不动杆菌定植、BSI 和类固醇治疗与 30 天死亡率相关。最后，COVID-19 患者、白细胞计数>11000mm、血清乳酸水平>2mmol/L、ICU 入院时感染、鲍曼不动杆菌定植和类固醇治疗与 BSI 的发生独立相关。
我们的数据强调了 BSI 对结局的影响、鲍曼不动杆菌定植的作用以及类固醇在 COVID-19 期间发生 MDR-AB 感染风险中的作用。
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