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. 2023 Apr 6;12(4):712.
doi: 10.3390/antibiotics12040712.

Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study

Davide Fiore Bavaro  1 , Nicolò De Gennaro  1 , Alessandra Belati  1 , Lucia Diella  1 , Roberta Papagni  1 , Luisa Frallonardo  1 , Michele Camporeale  1 , Giacomo Guido  1 , Carmen Pellegrino  1 , Maricla Marrone  2 , Alessandro Dell'Erba  2 , Loreto Gesualdo  3 , Nicola Brienza  4 , Salvatore Grasso  4 , Giuseppe Columbo  4 , Antonio Moschetta  5 , Giovanna Elisiana Carpagnano  6 , Antonio Daleno  7 , Anna Maria Minicucci  7 , Giovanni Migliore  8 , Annalisa Saracino  1
Affiliations

Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study

Davide Fiore Bavaro et al. Antibiotics (Basel). .

Abstract

Background: Antimicrobial and diagnostic stewardship (AS/DS) principles are crucial for the management of multidrug-resistant organisms (MDROs) infections. We evaluated the impact of a pro-active Infectious Disease (ID) consultation on the mortality risk of patients during an MDROs outbreak in a COVID-19 hospital.

Methods: A quasi-experimental study was performed in a dedicated COVID-19 hospital, including patients with suspected/confirmed infection and/or colonization by MDROs, which were managed as follows: (i) according to the standard of care during the pre-phase and (ii) in collaboration with a dedicated ID team performing a pro-active bedside evaluation every 48-72 h in the post-phase.

Results: Overall, 112 patients were included (pre-phase = 89 and post-phase = 45). The AS interventions included the following: therapy optimization (33%), de-escalation to narrow the spectrum (24%) or to lessen toxic drugs (20%), and discontinuation of antimicrobials (64%). DS included the request of additional microbiologic tests (82%) and instrumental exams (16%). With the Cox model, after adjusting for age, sex, COVID-19 severity, infection source, etiological agents, and post-phase attendance, only age predicted an increased risk of mortality, while attendance in the post-phase resulted in a decreased risk of mortality.

Conclusions: Implementation of AS and DS intervention through a pro-active ID consultation may reduce the risk of 28-day mortality of COVID-19 patients with MDROs infections.

Keywords: Acinetobacter baumannii; COVID-19; Infectious Diseases Consultation; KPC; bacterial infections; multidrug-resistant organisms.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Planimetry of “Presidio Maxi-Emergenze” COVID-19 Hospital.
Figure 2
Figure 2
Kaplan-Meier survival curves of survival probability according to phase of enrolment in “real life” cohort (panel (a)) and in the and IPTW-adjusted pseudo-population (panel (b)). Legend: overall survival probability of patients enrolled in pre-phase (blue line) and post-phase (red line). Overall survival probability of patients enrolled in the IPTW-adjusted pre-phase population (blue line) and IPTW-adjusted post-phase population (red line).
Figure 2
Figure 2
Kaplan-Meier survival curves of survival probability according to phase of enrolment in “real life” cohort (panel (a)) and in the and IPTW-adjusted pseudo-population (panel (b)). Legend: overall survival probability of patients enrolled in pre-phase (blue line) and post-phase (red line). Overall survival probability of patients enrolled in the IPTW-adjusted pre-phase population (blue line) and IPTW-adjusted post-phase population (red line).
See this image and copyright information in PMC

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