Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study).
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 >48â 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 30â day mortality.Results:
Overall, 123 patients (median age 66â 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) (nâ=â64, 52%), followed by urinary-tract infections (UTI) (nâ=â28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (nâ=â28, 22.8%), intra-abdominal infections (nâ=â2, 1.6%) and skin infections (nâ=â1, 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, Pâ=â0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33-11.77, Pâ=â0.004), lymphopenia on admission (HR 3, 95% CI 1.44-6.26, Pâ=â0.003) and age (HR 1.05, 95% CI 1.02-1.08, Pâ=â0.002) were predictors of 30â day mortality.Conclusions:
Superinfections by CRE were associated with high risk of 30â 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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