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Review
. 2022 May 21;11(1):74.
doi: 10.1186/s13756-022-01113-y.

Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020-2021

Marco Floridia  1 , Marina Giuliano  2 , Monica Monaco  3 , Luigi Palmieri  4 , Cinzia Lo Noce  4 , Anna Teresa Palamara  3 , Annalisa Pantosti  3 , Silvio Brusaferro  5 , Graziano Onder  4 ; Italian National Institute of Health COVID-19 Mortality Group
Collaborators, Affiliations
Review

Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020-2021

Marco Floridia et al. Antimicrob Resist Infect Control. .

Abstract

Background: Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19.

Methods: We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility.

Results: Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively.

Conclusions: In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.

Keywords: Antimicrobial resistance; Bacterial infections; Bloodstream infections; COVID-19; Co-infections; Fungal infections; Lower respiratory tract infections; Secondary infections.

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Conflict of interest statement

None to declare. None of the authors has a commercial or other association, financial interest, activity, relationship or association that might pose a conflict of interest.

Figures

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Median time to events from hospital admission
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