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Published on: March 17, 2014
Pseudomonas aeruginosa Infections in Patients with Severe COVID-19 in Intensive Care Units: A Retrospective Study
Alexandre Baudet1,2, Marie Regad1,3,4, Sébastien Gibot4,5
1INSPIIRE, Inserm, Université de Lorraine, F-54000 Nancy, France.
Insights
Patients with severe COVID-19 in the ICU frequently developed hospital-acquired Pseudomonas aeruginosa infections. Many infections involved multidrug-resistant strains, highlighting the need for improved treatment strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Patients hospitalized in intensive care units (ICUs) with severe COVID-19 face a significant risk of hospital-acquired infections.
- Pseudomonas aeruginosa is a common and dangerous pathogen causing infections in critically ill patients.
Purpose of the Study:
- To describe the occurrence and characteristics of Pseudomonas aeruginosa infections in severe COVID-19 patients during the initial pandemic waves.
- To analyze the antibiotic resistance patterns of P. aeruginosa strains.
- To review antibiotic treatment strategies for these infections.
Main Methods:
- Retrospective cohort study of adult patients with COVID-19 induced acute respiratory distress syndrome admitted to CHRU-Nancy ICU.
- Inclusion criteria: development of hospital-acquired P. aeruginosa infection during ICU stay.
- Data collected on patient demographics, comorbidities, infection timing, pathogen resistance, and antibiotic treatments.
Main Results:
- Fifty-one patients were included; most were male with comorbidities.
- P. aeruginosa infection was identified after a median ICU stay of 11 days.
- Significant proportions of infections involved multidrug-resistant (MDR, 27%) and extensively drug-resistant (XDR, 8%) strains.
- High resistance rates observed against penicillin + β-lactamase inhibitors (59%), cephalosporins (42%), monobactams (32%), and carbapenems (27%).
- Antibiotic treatment was initiated for 96% of patients, with subsequent adaptation in 51% based on antibiogram and 33% based on drug concentration.
Conclusions:
- Hospital-acquired P. aeruginosa infections are a common and serious complication in critically ill COVID-19 patients.
- The prevalence of MDR and XDR strains poses a significant challenge for effective treatment.
- Continued efforts are crucial to prevent and manage these infections, especially those caused by resistant bacteria.
Abstract:
Patients hospitalized in ICUs with severe COVID-19 are at risk for developing hospital-acquired infections, especially infections caused by Pseudomonas aeruginosa. We aimed to describe the evolution of P. aeruginosa infections in ICUs at CHRU-Nancy (France) in patients with severe COVID-19 during the three initial waves of COVID-19. The second aims were to analyze P. aeruginosa resistance and to describe the antibiotic treatments. We conducted a retrospective cohort study among adult patients who were hospitalized for acute respiratory distress syndrome due to COVID-19 and who developed a hospital-acquired infection caused by P. aeruginosa during their ICU stay. Among the 51 patients included, most were male (90%) with comorbidities (77%), and the first identification of P. aeruginosa infection occurred after a median ICU stay of 11 days. Several patients acquired infections with MDR (27%) and XDR (8%) P. aeruginosa strains. The agents that strains most commonly exhibited resistance to were penicillin + β-lactamase inhibitors (59%), cephalosporins (42%), monobactams (32%), and carbapenems (27%). Probabilistic antibiotic treatment was prescribed for 49 patients (96%) and was subsequently adapted for 51% of patients after antibiogram and for 33% of patients after noncompliant antibiotic plasma concentration. Hospital-acquired infection is a common and life-threatening complication in critically ill patients. Efforts to minimize the occurrence and improve the treatment of such infections, including infections caused by resistant strains, must be pursued.
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