Antimicrobial Therapy as a Risk Factor of Multidrug-Resistant Acinetobacter Infection in COVID-19 Patients Admitted...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Multidrug-resistant Acinetobacter (MDR-Ab) poses a significant threat, causing superinfections in intensive care unit (ICU) COVID-19 patients.
• MDR-Ab superinfections worsen patient prognosis in the ICU.
• Overuse of antibiotics in COVID-19 patients may contribute to the rise of MDR-Ab infections.

Purpose of the Study:

• To determine if prior antibiotic exposure independently predicts MDR-Ab infection in ICU-admitted COVID-19 patients.
• To identify risk factors associated with MDR-Ab superinfections in this vulnerable patient population.

Main Methods:

• A retrospective cohort study was conducted involving 90 COVID-19 patients admitted to the ICU between September 2021 and January 2022.
• Patients underwent regular microbial screening, with superinfections defined as those occurring ≥48 hours post-admission.
• Statistical analysis assessed prior antibiotic exposure and other factors as independent predictors of MDR-Ab isolation.

Main Results:

• Of 90 patients, 36.7% developed MDR-Ab superinfections.
• Prior exposure to ceftriaxone (OR 4.1), tocilizumab therapy (OR 4.7), and ICU stays exceeding 11 days (OR 3.7) were independent predictors of MDR-Ab infection.
• Ceftriaxone was the most common prior antibiotic, used in 64.8% of patients exposed to antibiotics before MDR-Ab isolation.

Conclusions:

• Prior ceftriaxone exposure is a significant risk factor for MDR-Ab infection in ICU-admitted COVID-19 patients.
• Findings support restricting antibiotic use in COVID-19 ICU patients to those with confirmed bacterial superinfections.
• Judicious antibiotic stewardship is crucial to mitigate the development of MDR-Ab infections in critical care settings.