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Multicenter Study
. 2021 Oct;49(10):1256-1261.
doi: 10.1016/j.ajic.2021.06.005. Epub 2021 Jun 17.

Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study

Hyo-Ju Son  1 , Tark Kim  2 , Eunjung Lee  3 , Se Yoon Park  3 , Shinae Yu  4 , Hyo-Lim Hong  5 , Min-Chul Kim  6 , Sun In Hong  7 , Seongman Bae  8 , Min Jae Kim  8 , Sung-Han Kim  8 , Ji Hyun Yun  9 , Kyeong Min Jo  10 , Yu-Mi Lee  11 , Seungjae Lee  3 , Jung Wan Park  4 , Min Hyok Jeon  4 , Tae Hyong Kim  3 , Eun Ju Choo  12
Affiliations
Multicenter Study

Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: A multicenter study

Hyo-Ju Son et al. Am J Infect Control. 2021 Oct.

Abstract

Objectives: Superimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment.

Methods: All eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated.

Results: Of 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (5 isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (4 isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% vs 15%; P = .001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; P = .004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; P = .048) were associated with MDRO isolation.

Conclusions: MDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors.

Keywords: Antimicrobial resistance; COVID-19; Corticosteroids; Long-term care facility; SARS-CoV-2.

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Figures

Fig 1
Fig. 1
Study flowchart.
Fig 2
Fig. 2
Timelines of 13 patients with coronavirus disease 2019 and isolation of multi-drug resistant microorganism.
See this image and copyright information in PMC

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