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Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study).
Falcone, Marco; Suardi, Lorenzo Roberto; Tiseo, Giusy; Galfo, Valentina; Occhineri, Sara; Verdenelli, Stefano; Ceccarelli, Giancarlo; Poli, Melita; Merli, Marco; Bavaro, Davide; Carretta, Anna; Nunnari, Giuseppe; Venanzi Rullo, Emmanuele; Trecarichi, Enrico Maria; Papalini, Chiara; Franco, Antonina; Del Vecchio, Rosa Fontana; Bianco, Vincenzo; Punzi, Rodolfo; Francisci, Daniela; Rubino, Raffaella; Torti, Carlo; Puoti, Massimo; Carbonara, Sergio; Cascio, Antonio; Saracino, Annalisa; Santantonio, Teresa; Venditti, Mario; Menichetti, Francesco.
  • Falcone M; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Suardi LR; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Tiseo G; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Galfo V; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Occhineri S; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Verdenelli S; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
  • Ceccarelli G; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
  • Poli M; Vittorio Emanuele II Hospital, Bisceglie, Italy.
  • Merli M; Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Bavaro D; University of Bari, Clinic of Infectious Diseases, Bari, Italy.
  • Carretta A; Department of Infectious Diseases, University Hospital 'Ospedali Riuniti' of Foggia, Foggia, Italy.
  • Nunnari G; Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
  • Venanzi Rullo E; Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
  • Trecarichi EM; Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro-'Mater Domini' Teaching Hospital, Catanzaro, Italy.
  • Papalini C; Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy.
  • Franco A; UOC Malattie Infettive, PO Umberto I, Siracusa, Italy.
  • Del Vecchio RF; UOC Malattie Infettive, PO Umberto I, Siracusa, Italy.
  • Bianco V; Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy.
  • Punzi R; Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy.
  • Francisci D; Department of Medicine and Surgery, Clinic of Infectious Diseases, 'Santa Maria della Misericordia' Hospital, University of Perugia, Perugia, Italy.
  • Rubino R; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
  • Torti C; Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro-'Mater Domini' Teaching Hospital, Catanzaro, Italy.
  • Puoti M; Divisione di Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Carbonara S; Vittorio Emanuele II Hospital, Bisceglie, Italy.
  • Cascio A; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy.
  • Saracino A; University of Bari, Clinic of Infectious Diseases, Bari, Italy.
  • Santantonio T; Department of Infectious Diseases, University Hospital 'Ospedali Riuniti' of Foggia, Foggia, Italy.
  • Venditti M; Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
  • Menichetti F; Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy.
JAC Antimicrob Resist ; 4(3): dlac064, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1961072
ABSTRACT

Objectives:

To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE).

Methods:

Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-ß-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality.

Results:

Overall, 123 patients (median age 66 years, IQR 59-75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) (n = 64, 52%), followed by urinary-tract infections (UTI) (n = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (n = 28, 22.8%), intra-abdominal infections (n = 2, 1.6%) and skin infections (n = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09-24.97, P = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33-11.77, P = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44-6.26, P = 0.003) and age (HR 1.05, 95% CI 1.02-1.08, P = 0.002) were predictors of 30 day mortality.

Conclusions:

Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: JAC Antimicrob Resist Year: 2022 Document Type: Article Affiliation country: Jacamr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal: JAC Antimicrob Resist Year: 2022 Document Type: Article Affiliation country: Jacamr