Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 14:2023:4951273.
doi: 10.1155/2023/4951273. eCollection 2023.

Antimicrobial Therapy as a Risk Factor of Multidrug-Resistant Acinetobacter Infection in COVID-19 Patients Admitted to the Intensive Care Unit

P Mihalov  1 , J Hodosy  2   3 , A Koščálová  1 , M Čaprnda  4 , M Kachlíková  1 , J Jurenka  1 , M Bendžala  1 , P Sabaka  1
Affiliations

Antimicrobial Therapy as a Risk Factor of Multidrug-Resistant Acinetobacter Infection in COVID-19 Patients Admitted to the Intensive Care Unit

P Mihalov et al. Can J Infect Dis Med Microbiol. .

Abstract

Background: Multidrug-resistant Acinetobacter (MDR-Ab) is one of the most important pathogens causing superinfections in COVID-19 patients hospitalised in the intensive care unit (ICU). The occurrence of MDR-Ab superinfection significantly impairs the prognosis of patients in the ICU. Overuse of antibiotics in COVID-19 patients might contribute to the risk of developing MDR-Ab infection.

Objective: The objective was to assess the role of prior antibiotic exposure as an independent predictor of MDR-Ab infection in COVID-19 patients admitted to the ICU.

Methods: We conducted a retrospective cohort study in 90 patients admitted to the ICU of the Department of Infectology and Geographical Medicine, University Hospital in Bratislava, for respiratory failure due to COVID-19 between 1 September 2021 and 31 January 2022 (delta variant predominance). Patients underwent regular microbial screening. Superinfection was defined as infection occurring ≥48 h after admission. We assessed the role of prior antibiotic exposure and other factors as independent predictors of MDR-Ab isolation.

Results: Fifty-eight male and 32 female patients were included in the analysis. Multidrug-resistant bacteria were cultured in 43 patients (47.8%), and MDR-Ab was isolated in 37 patients. Thirty-three (36.7%) patients had superinfection caused by MDR-Ab. Fifty-four (60%) patients were exposed to antibiotics prior to MDR-Ab isolation; of those, 35 (64.8%) patients received ceftriaxone. Prior exposure to ceftriaxone (odds ratio (OR) 4.1; 95% confidence interval (CI) 1.4-11.9; P < 0.05), tocilizumab therapy (OR 4.7; 95% CI 1.3-15.0; P < 0.05), and ICU length of stay exceeding 11 days (OR 3.7; 95% CI 1.3-10.3; P < 0.05) were independent predictors of MDR-Ab infection.

Conclusions: Prior exposure to ceftriaxone increases the risk of MDR-Ab infection in COVID-19 patients admitted to the ICU. Our findings suggest that antibiotic use in COVID-19 patients admitted to the ICU should be restricted to patients with documented bacterial superinfection.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Similar articles

See all similar articles

References

    1. Wiersinga W. J., Rhodes A., Cheng A. C., Peacock S. J., Prescott H. C. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA . 2020;324(8):782–793. doi: 10.1001/jama.2020.12839. - DOI - PubMed
    1. Clancy C. J., Nguyen M. H. Coronavirus disease 2019, superinfections, and antimicrobial development: what can we expect? Clinical Infectious Diseases . 2020;71(10):2736–2743. doi: 10.1093/cid/ciaa524. - DOI - PMC - PubMed
    1. Gudiol C., Durà-Miralles X., Aguilar-Company J., et al. Co-infections and superinfections complicating COVID-19 in cancer patients: a multicentre, international study. Journal of Infection . 2021;83(3):306–313. doi: 10.1016/j.jinf.2021.07.014. - DOI - PMC - PubMed
    1. Karami Z., Knoop B. T., Dofferhoff A. S. M., et al. Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands. Infectious Diseases . 2021;53(2):102–110. doi: 10.1080/23744235.2020.1839672. - DOI - PubMed
    1. Pickens C. O., Gao C. A., Cuttica M. J., et al. Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia. American Journal of Respiratory and Critical Care Medicine . 2021;204(8):921–932. doi: 10.1164/rccm.202106-1354OC. - DOI - PMC - PubMed

LinkOut - more resources