Background: Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19. Methods: We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility. Results: Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively. Conclusions: In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.
Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021 / Floridia, M.; Giuliano, M.; Monaco, M.; Palmieri, L.; Lo Noce, C.; Palamara, A. T.; Pantosti, A.; Brusaferro, S.; Onder, G.; Agazio, E.; Barbariol, P.; Bella, A.; Benelli, E.; Bertinato, L.; Bocci, M.; Boros, S.; Bressi, M.; Calcagnini, G.; Canevelli, M.; Censi, F.; Ciervo, A.; Colaizzo, E.; Da Cas, R.; Del Manso, M.; Di Benedetto, C.; Donfrancesco, C.; Fabiani, M.; Facchiano, F.; Floridia, M.; Galati, F.; Grisetti, T.; Guastadisegni, C.; Lega, I.; Maiozzi, P.; Manno, V.; Martini, M.; Massari, M.; Urdiales, A. M.; Mattei, E.; Meduri, C.; Meli, P.; Menniti Ippolito, F.; Minelli, G.; Petrone, D.; Pezzotti, P.; Pricci, F.; Punzo, O.; Quarata, F.; Raparelli, V.; Riccardo, F.; Rocchetto, S.; Sacco, C.; Salerno, P.; Sarti, G.; Serra, D.; Spila Alegiani, S.; Spuri, M.; Tallon, M.; Tamburo De Bella, M.; Tiple, D.; Toccaceli Blasi, M.; Trentin, F.; Unim, B.; Vaianella, L.; Vanacore, N.; Vescio, M. F.; Villani, E. R.; Weimer, L. E.. - In: ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL. - ISSN 2047-2994. - 11:1(2022), p. 74. [10.1186/s13756-022-01113-y]
Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021
Palamara A. T.;Brusaferro S.;Onder G.;Canevelli M.;Colaizzo E.;Del Manso M.;Facchiano F.;Manno V.;Meli P.;Minelli G.;Punzo O.;Raparelli V.;Rocchetto S.;Salerno P.;Spila Alegiani S.;Tamburo De Bella M.;Toccaceli Blasi M.;Unim B.;Vanacore N.;
2022
Abstract
Background: Patients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19. Methods: We reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility. Results: Among 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively. Conclusions: In hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
