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. 2024 Jun 26;16(2):60-67.
doi: 10.4103/jgid.jgid_108_23. eCollection 2024 Apr-Jun.

Associated Risk Factors and Clinical Outcomes of Bloodstream Infections among COVID-19 Intensive Care Unit Patients in a Tertiary Care Hospital

Mahalakshmamma Dasarahalli Shivalingappa  1 , Supriya Gachinmath  1 , Shiva Kumar Narayan  2
Affiliations

Associated Risk Factors and Clinical Outcomes of Bloodstream Infections among COVID-19 Intensive Care Unit Patients in a Tertiary Care Hospital

Mahalakshmamma Dasarahalli Shivalingappa et al. J Glob Infect Dis. .

Abstract

Introduction: The COVID-19 infection is an ongoing public health crisis causing millions of deaths worldwide. COVID-19 patients admitted to the intensive care unit (ICU) are more vulnerable to acquire secondary bloodstream infections (sBSIs) which cause a significant morbidity and mortality. Thus, we aim to assess the risk factors of sBSIs and outcomes in COVID-19 ICU patients.

Methods: One hundred blood culture samples with growth (cases) and other 100 blood culture with no growth(controls) were collected.. All the demographic data, laboratory data and antimicrobial resistance pattern were analysed . Blood culture bottle received in the Microbiology laboratory were loaded into Automated blood culture system. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing.

Results: Raised C-reactive protein (CRP) (P = 0.0035), interleukin-6 (P = 0.0404), mechanical ventilation (MV) (P = 0.024), prior antimicrobial exposure (P = 0.002), longer ICU stay with median 11 days (P = 0.022), and higher mortality rate (P = 0.001) were significantly associated with the BSI. A significant proportion of BSIs were Gram-negative bacteria (n = 115) such as Acinetobacter baumannii 38 (33%) and Klebsiella pneumoniae 30 (26%). Monomicrobial organisms in blood yielded a higher proportion in our study 72 (72%). The highest resistance for Acinetobacter species (50) was observed with ceftazidime 29 (96.6%) amikacin 48 (96%), meropenem 48 (96%), cefotaxime 47 (94%), ciprofloxacin 46 (92%), and netilmicin 46 (92%). K. pneumoniae was highly resistant to cefotaxime 29 (96.6%), ceftazidime 29 (96.6%), ciprofloxacin 22 (73.3%), and cefuroxime 21 (70%). Among Gram-positive organisms, Enterococcus species showed that a resistance for high-level gentamicin and penicillin was 66.6%.

Conclusions: Raised CRP, need of MV, prior antimicrobial exposure, and longer ICU stay should alarm clinicians for BSI. Hence, our study highlights the associated risk factors for BSI and emphasizes adherence to hospital infection control policies and antibiotic stewardship program.

Keywords: Antimicrobial resistance; COVID-19; intensive care unit; secondary bloodstream infections.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Methodology used for blood sample collection and processing of sample from case (BSI) and control (no BSI) patients admitted to COVID-19 intensive care unit
Figure 2
Figure 2
Distribution of Gram-positive bacteria isolated from blood with COVID-19 intensive care unit patients (n = 32). MRSA: Methicillin-resistance Staphylococcus aureus
Figure 3
Figure 3
Distribution of Gram-negative bacteria isolated from blood among COVID-19 intensive care unit patients (n = 115)
See this image and copyright information in PMC

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