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Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19

Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill...

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Autores principales: Pasero, Daniela, Cossu, Andrea Pasquale, Terragni, Pierpaolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402127/
https://www.ncbi.nlm.nih.gov/pubmed/34442852
http://dx.doi.org/10.3390/microorganisms9081773
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author Pasero, Daniela
Cossu, Andrea Pasquale
Terragni, Pierpaolo
author_facet Pasero, Daniela
Cossu, Andrea Pasquale
Terragni, Pierpaolo
author_sort Pasero, Daniela
collection PubMed
description Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results.
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spelling pubmed-84021272021-08-29 Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19 Pasero, Daniela Cossu, Andrea Pasquale Terragni, Pierpaolo Microorganisms Review Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results. MDPI 2021-08-20 /pmc/articles/PMC8402127/ /pubmed/34442852 http://dx.doi.org/10.3390/microorganisms9081773 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Pasero, Daniela
Cossu, Andrea Pasquale
Terragni, Pierpaolo
Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
title Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
title_full Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
title_fullStr Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
title_full_unstemmed Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
title_short Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
title_sort multi-drug resistance bacterial infections in critically ill patients admitted with covid-19
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8402127/
https://www.ncbi.nlm.nih.gov/pubmed/34442852
http://dx.doi.org/10.3390/microorganisms9081773
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