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. 2022 Jun 29;10(7):1314.
doi: 10.3390/microorganisms10071314.

Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients' Outcome

Affiliations

Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients' Outcome

Efthymia Giannitsioti et al. Microorganisms. .

Abstract

Background: Bloodstream infections (BSI) caused by highly resistant pathogens in non-ICU COVID-19 departments pose important challenges. Methods: We performed a comparative analysis of incidence and microbial epidemiology of BSI in COVID-19 vs. non-COVID-19, non-ICU departments between 1 September 2020-31 October 2021. Risk factors for BSI and its impact on outcome were evaluated by a case-control study which included COVID-19 patients with/without BSI. Results: Forty out of 1985 COVID-19 patients developed BSI. The mean monthly incidence/100 admissions was 2.015 in COVID-19 and 1.742 in non-COVID-19 departments. Enterococcus and Candida isolates predominated in the COVID-19 group (p < 0.001 and p = 0.018, respectively). All Acinetobacter baumannii isolates were carbapenem-resistant (CR). In the COVID-19 group, 33.3% of Klebsiella pneumoniae was CR, 50% of Escherichia coli produced ESBL and 19% of Enterococcus spp. were VRE vs. 74.5%, 26.1% and 8.8% in the non-COVID-19 group, respectively. BSI was associated with prior hospitalization (p = 0.003), >2 comorbidities (p < 0.001), central venous catheter (p = 0.015), severe SARS-CoV-2 pneumonia and lack of COVID-19 vaccination (p < 0.001). In the multivariate regression model also including age and multiple comorbidities, only BSI was significantly associated with adverse in-hospital outcome [OR (CI95%): 21.47 (3.86−119.21), p < 0.001]. Conclusions: BSI complicates unvaccinated patients with severe SARS-CoV-2 pneumonia and increases mortality. BSI pathogens and resistance profiles differ among COVID-19/non-COVID-19 departments, suggesting various routes of pathogen acquisition.

Keywords: COVID-19; SARS-CoV-2 pneumonia; antimicrobial resistance; bacteremia; bloodstream infections; catheter-related bloodstream infection; fungemia; multidrug resistant organisms.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Monthly number of BSI episodes and monthly admissions in COVID-19 and non-COVID-19 departments, except ICU.
Figure 2
Figure 2
Resistance profiles of blood isolates among the COVID-19 department and all other non-ICU departments. Footnotes: CRAB—carbapenem resistant Acinetobacter baumannii; CRKP—carbapenem-resistant Klebsiella pneumoniae; P. aeruginosa CR (carbapenem-resistant); VRE—vancomycin resistant Enterococci; MRSA—methicillin-resistant Staphylococcus aureus; statistical significance * p = 0.047, ** p = 0.002, *** p = 0.042.

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