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Device-Associated Infections in COVID-19 Patients: Frequency of Resistant Bacteria, Predictors and Mortality in
Diana Patricia Ocampo1, Lina María Echeverri-Toro1,2, Judy Natalia Jiménez3
1Faculty of Medicine, School of Health Sciences, Pontifical Bolivarian University, Medellín 050031, Colombia.
Introduction:
Increased antimicrobial use during the COVID-19 pandemic has raised concerns about the spread of resistant bacteria. This study analyzed the frequency of device-associated infections (DAI) caused by resistant bacteria, the predictors of these infections, and 30-day all-cause mortality in patients with and without COVID-19.
Methods:
A retrospective cohort study was conducted on DAI patients admitted to the ICU (intensive care unit) in 20 hospitals in Medellin, Colombia (2020-2021). The exposure assessed was the COVID-19 diagnosis, and outcomes analyzed were resistant bacterial infections and 30-day mortality. Clinical and microbiological information was collected from surveillance databases. Statistical analysis included generalized linear mixed-effects models.
Results:
Of the 1521 patients included, 1033 (67.9%) were COVID-19-positive and 1665 DAI were presented. Carbapenem-resistant Enterobacteriaceae (CRE) infections predominated during the study (n = 98; 9.9%). The patients with COVID-19 had a higher frequency of metallo-beta-lactamase-producing CRE infections (n = 15; 33.3%) compared to patients without the disease (n = 3; 13.0%). Long-stay in the ICU (RR: 2.09; 95% CI: 1.39-3.16), diabetes (RR: 1.73; 95% CI: 1.21-2.49), and mechanical ventilation (RR: 2.13; 95% CI: 1.01-4.51) were CRE infection predictors in COVID-19 patients, with a mortality rate of 60.3%.
Conclusion:
CRE infections were predominant in COVID-19 patients. In pandemic situations, the strategies to control DAI should be maintained to avoid infections caused by resistant bacteria, such as length of stay in the ICU and duration of mechanical ventilation.
Insights
Device-associated infections (DAI) with carbapenem-resistant Enterobacteriaceae (CRE) were more common in COVID-19 patients. Maintaining DAI control strategies is crucial during pandemics to prevent resistant bacterial infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- The COVID-19 pandemic led to increased antimicrobial use, raising concerns about antimicrobial resistance.
- Device-associated infections (DAI) are a significant threat, particularly in intensive care units (ICUs).
- Understanding the impact of COVID-19 on DAI caused by resistant bacteria is critical.
Purpose of the Study:
- To analyze the frequency of DAI caused by resistant bacteria in patients with and without COVID-19.
- To identify predictors of these infections and their association with 30-day mortality.
- To evaluate the specific impact of COVID-19 on carbapenem-resistant Enterobacteriaceae (CRE) infections.
Main Methods:
- Retrospective cohort study of DAI patients in 20 hospitals in Medellin, Colombia (2020-2021).
- Comparison of outcomes between patients with and without COVID-19 diagnosis.
- Statistical analysis using generalized linear mixed-effects models to identify predictors and mortality risks.
Main Results:
- Carbapenem-resistant Enterobacteriaceae (CRE) infections were predominant (9.9% of DAI).
- COVID-19 patients showed a higher frequency of metallo-beta-lactamase-producing CRE infections (33.3% vs 13.0%).
- Predictors for CRE in COVID-19 patients included long ICU stay, diabetes, and mechanical ventilation, with a 60.3% mortality rate.
Conclusions:
- CRE infections were a significant issue in COVID-19 patients.
- Pandemic situations necessitate sustained strategies for DAI control to combat resistant bacteria.
- Key areas for intervention include managing ICU length of stay and duration of mechanical ventilation.
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