Antimicrobial Therapy as a Risk Factor of Multidrug-Resistant Acinetobacter Infection in COVID-19 Patients Admitted to the Intensive Care Unit

• Published in: The Canadian journal of infectious diseases & medical microbiology 2023-09, Vol.2023, p.4951273-8
• Main Authors: Mihalov, P., Hodosy, J., Koščálová, A., Čaprnda, M., Kachlíková, M., Jurenka, J., Bendžala, M., Sabaka, P.
• Format: Article
• Language: English
• Subjects: Acinetobacter; Acinetobacter infections; Antibacterial agents; Antibiotics; Antimicrobial agents; Bacteria; Catheters; Ceftriaxone; Complications and side effects; COVID-19; Development and progression; Diagnosis; Exposure; Health aspects; Hospital patients; Hospitalization; Hospitals; Infection; Infectious diseases; Intensive care; Intubation; Length of stay; Medical research; Medicine, Experimental; Microorganisms; Multidrug resistance; Multidrug resistant organisms; Oxygen therapy; Pathogens; Patient outcomes; Patients; Pneumonia; Prognosis; Resistance factors; Respiratory failure; Risk factors; Sepsis; Severe acute respiratory syndrome coronavirus 2; Sulbactam; Superinfection; Urinary tract diseases; Urinary tract infections; Urogenital system; Ventilators
• ISSN: 1712-9532; 1918-1493
• DOI: 10.1155/2023/4951273

Background. Multidrug-resistant Acinetobacter (MDR-Ab) is one of the most important pathogens causing superinfections in COVID-19 patients hospitalised in the intensive care unit (ICU). The occurrence of MDR-Ab superinfection significantly impairs the prognosis of patients in the ICU. Overuse of antibiotics in COVID-19 patients might contribute to the risk of developing MDR-Ab infection. Objective. The objective was to assess the role of prior antibiotic exposure as an independent predictor of MDR-Ab infection in COVID-19 patients admitted to the ICU. Methods. We conducted a retrospective cohort study in 90 patients admitted to the ICU of the Department of Infectology and Geographical Medicine, University Hospital in Bratislava, for respiratory failure due to COVID-19 between 1 September 2021 and 31 January 2022 (delta variant predominance). Patients underwent regular microbial screening. Superinfection was defined as infection occurring ≥48 h after admission. We assessed the role of prior antibiotic exposure and other factors as independent predictors of MDR-Ab isolation. Results. Fifty-eight male and 32 female patients were included in the analysis. Multidrug-resistant bacteria were cultured in 43 patients (47.8%), and MDR-Ab was isolated in 37 patients. Thirty-three (36.7%) patients had superinfection caused by MDR-Ab. Fifty-four (60%) patients were exposed to antibiotics prior to MDR-Ab isolation; of those, 35 (64.8%) patients received ceftriaxone. Prior exposure to ceftriaxone (odds ratio (OR) 4.1; 95% confidence interval (CI) 1.4–11.9; P