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Multidrug-Resistant Bacterial Colonization and Infections in Large Retrospective Cohort of Mechanically Ventilated
Abstract:
Few data are available on incidence of multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients, particularly during the COVID-19 pandemic. We retrospectively evaluated all patients admitted to the COVID-19 intensive care unit (ICU) of Hub Hospital in Milan, Italy, during October 2020‒May 2021. Microbiologic surveillance was standardized with active screening at admission and weekly during ICU stay. Of 435 patients, 88 (20.2%) had MDROs isolated ≤48 h after admission. Of the remaining patients, MDRO colonization was diagnosed in 173 (51.2%), MDRO infections in 95 (28.1%), and non-MDRO infections in 212 (62.7%). Non-MDRO infections occurred earlier than MDRO infections (6 days vs. 10 days; p<0.001). Previous exposure to antimicrobial drugs within the ICU was higher in MDRO patients than in non-MDRO patients (116/197 [58.9%] vs. 18/140 [12.9%]; p<0.001). Our findings might serve as warnings for future respiratory viral pandemics and call for increased measures of antimicrobial stewardship and infection control.
Insights
Multidrug-resistant organism (MDRO) colonization and infections are common in mechanically ventilated COVID-19 patients. Increased antimicrobial stewardship and infection control are crucial for future pandemics.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Limited data exist on multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients during the COVID-19 pandemic.
- Understanding MDRO epidemiology in this vulnerable population is critical for effective infection control.
Purpose of the Study:
- To determine the incidence of MDRO colonization and infections in mechanically ventilated patients admitted to a COVID-19 intensive care unit (ICU).
- To identify risk factors associated with MDRO acquisition and infection in this cohort.
Main Methods:
- Retrospective evaluation of 435 mechanically ventilated patients in a COVID-19 ICU from October 2020 to May 2021.
- Standardized microbiologic surveillance including admission screening and weekly monitoring for MDROs.
- Analysis of patient data to compare characteristics between MDRO-positive and MDRO-negative groups.
Main Results:
- 20.2% of patients had MDROs isolated within 48 hours of admission.
- Among remaining patients, 51.2% developed MDRO colonization and 28.1% developed MDRO infections.
- MDRO infections occurred later than non-MDRO infections (10 days vs. 6 days), and prior antimicrobial exposure was significantly higher in MDRO patients (58.9% vs. 12.9%).
Conclusions:
- High rates of MDRO colonization and infection were observed in mechanically ventilated COVID-19 patients.
- Findings highlight the need for enhanced antimicrobial stewardship and infection control measures, especially during viral pandemics.
- These results serve as a warning for future pandemic preparedness.
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