MDR Bacteremia in the Critically Ill During COVID-19: The MARTINI Study

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Epidemiology

Background:

• Multidrug-resistant (MDR) bloodstream infections (BSIs) are a significant threat in intensive care units (ICUs).
• The COVID-19 pandemic may have exacerbated the incidence of MDR infections due to compromised infection control measures.
• Limited comparative data exists on MDR BSIs between COVID-19 and non-COVID-19 ICU populations.

Purpose of the Study:

• To compare the characteristics, resistance patterns, and outcomes of MDR BSIs in adult patients admitted to COVID-19 ICUs versus non-COVID-19 ICUs.
• To identify independent predictors of ICU mortality in patients with MDR BSIs during the COVID-19 pandemic.

Main Methods:

• Retrospective observational study (MARTINI) conducted in a tertiary hospital from 2020-2022.
• Inclusion of adult patients with MDR BSIs admitted to COVID-19 and non-COVID-19 ICUs.
• Analysis of demographics, comorbidities, severity scores, microbiology, resistance patterns, and outcomes, with multivariate regression for mortality predictors.

Main Results:

• COVID-19 ICU patients were older with higher comorbidity and severity scores compared to non-COVID-19 ICU patients.
• Gram-negative pathogens, primarily *Acinetobacter baumannii* and *Klebsiella pneumoniae*, predominated in both groups with similar resistance.
• ICU mortality was significantly higher in COVID-19 ICU patients (74.5%) versus non-COVID-19 ICU patients (38%).
• Age, SOFA score, SIRS, and COVID-19 infection were independent predictors of mortality.

Conclusions:

• Despite similar pathogen profiles and resistance, COVID-19 ICU patients experienced substantially higher mortality from MDR BSIs.
• COVID-19 infection is an independent predictor of mortality in critically ill patients with MDR BSIs.
• Strengthened infection control protocols and prompt, targeted antimicrobial therapy are crucial for mitigating MDR bacteremia risk in critically ill patients.