Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020-2021)

Monica Monaco; Marco Floridia; Marina Giuliano; Luigi Palmieri; Cinzia Lo Noce; Annalisa Pantosti; Anna Teresa Palamara; Silvio Brusaferro; Graziano Onder; Italian National Institute of Health COVID-19 Mortality Group

doi:10.3389/fmed.2022.1041668

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020-2021)

Front Med (Lausanne). 2022 Nov 17:9:1041668. doi: 10.3389/fmed.2022.1041668. eCollection 2022.

Authors

Monica Monaco¹, Marco Floridia², Marina Giuliano², Luigi Palmieri³, Cinzia Lo Noce³, Annalisa Pantosti¹, Anna Teresa Palamara¹, Silvio Brusaferro⁴, Graziano Onder³; Italian National Institute of Health COVID-19 Mortality Group

Collaborators

Italian National Institute of Health COVID-19 Mortality Group:
Luigi Palmieri, Elvira Agazio, Pierfrancesco Barbariol, Antonino Bella, Eva Benelli, Luigi Bertinato, Matilde Bocci, Stefano Boros, Marco Bressi, Giovanni Calcagnini, Federica Censi, Alessandra Ciervo, Elisa Colaizzo, Cecilia Damiano, Martina Del Manso, Corrado Di Benedetto, Chiara Donfrancesco, Massimo Fabiani, Francesco Facchiano, Marco Floridia, Fabio Galati, Marina Giuliano, Tiziana Grisetti, Cecilia Guastadisegni, Cinzia Lo Noce, Pietro Maiozzi, Valerio Manno, Margherita Martini, Alberto Mateo Urdiales, Eugenio Mattei, Claudia Meduri, Paola Meli, Giada Minelli, Graziano Onder, Daniele Petrone, Patrizio Pezzotti, Flavia Pricci, Ornella Punzo, Flavia Riccardo, Chiara Sacco, Paolo Salerno, Debora Serra, Matteo Spuri, Marco Tallon, Manuela Tamburo De Bella, Dorina Tiple, Brigid Unim, Luana Vaianella, Maria Fenicia Vescio, Liliana Elena Weimer, Silvio Brusaferro

Affiliations

¹ Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
² National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy.
³ Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
⁴ Office of the President, Istituto Superiore di Sanità, Rome, Italy.

Abstract

Introduction: In hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance.

Methods: Hospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses.

Results: The study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018).

Conclusions: In patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.

Keywords: COVID-19; antimicrobial resistance; bacterial infections; bloodstream infections; fungal infections; secondary infections.