Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study). Issue 3 (16th June 2022)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: JAC-antimicrobial resistance. Volume 4:Issue 3(2022)
• Publication Date: 2022-06-16
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; Drug resistance in microorganisms -- Periodicals; 616.9041
• DOI: 10.1093/jacamr/dlac064
• Languages: English
• ISSNs: 2632-1823

Abstract

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-β-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.