The Acquisition of Multidrug-Resistant Bacteria in Patients Admitted to COVID-19 Intensive Care Units: A Monocentric Retrospective Case Control Study

Whether the risk of multidrug-resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is modified by the COVID-19 crisis is unknown. In this single center case control study, we measured the rate of MDRB acquisition in patients admitted in COVID-19 ICU and compared it with patients admitted in the same ICU for subarachnoid hemorrhage (controls) matched 1:1 on length of ICU stay and mechanical ventilation. All patients were systematically and repeatedly screened for MDRB carriage. We compared the rate of MDRB acquisition in COVID-19 patients and in control using a competing risk analysis. Of note, although we tried to match COVID-19 patients with septic shock patients, we were unable due to the longer stay of COVID-19 patients. Among 72 patients admitted to the COVID-19 ICUs, 33% acquired 31 MDRB during ICU stay. The incidence density of MDRB acquisition was 30/1000 patient days. Antimicrobial therapy and exposure time were associated with higher rate of MDRB acquisition. Among the 72 SAH patients, 21% acquired MDRB, with an incidence density was 18/1000 patient days. The septic patients had more comorbidities and a greater number of previous hospitalizations than the COVID-19 patients. The incidence density of MDRB acquisition was 30/1000 patient days. The association between COVID-19 and MDRB acquisition (compared to control) risk did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93–3.21)). Thus, we conclude that, despite strong physical isolation, acquisition rate of MDRB in ICU patients was at least similar during the COVID-19 first wave compared to previous period.

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The acquisition of Multi-drug resistant bacteria in patients admitted to COVID-19 intensive care units: a monocentric retrospective case control study

10.21203/rs.3.rs-67837/v1 ◽

2020 ◽

Author(s):

Elisa Gouvêa Bogossian ◽

Fabio Silvio Taccone ◽

Antonio Izzi ◽

Nicolas Yin ◽

Alessandra Garufi ◽

...

Keyword(s):

Intensive Care ◽

Risk Analysis ◽

Case Control Study ◽

Statistical Significance ◽

Case Control ◽

Competing Risk ◽

Resistant Bacteria ◽

Competing Risk Analysis ◽

Icu Stay ◽

Control Study

Abstract Background: Whether the risk of multidrug resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is increased during the COVID-19 crisis is unknown. Our aim was to measure the rate of MDRB acquisition in patients admitted in COVID-19 ICU and to compare it with pre-COVID-19 controls.Methods: This single center case control study included adult patients admitted to COVID-19 ICUs for more than 48h. Patients were screen twice a week for MDRB carriage during ICU stay. We compared the rate of MDRB acquisition of COVID-19 patients with a cohort of patients admitted for subarachnoid hemorrhage (SAH) and matched on length of ICU stay using a competing risk analysis.Results: Among 72 patients admitted to the COVID-19 ICUs, 24 (33%) patients acquired 31 MDRB during ICU stay. The rate of MDRB acquisition was 30/1000 patient-days. Patients that acquired MDRB had received more antimicrobial therapy [22 (92%) vs 34 (78%, p=0.05] and had a longer exposure time [12 days (8-18) vs 5 days (2-18), p=0.02]. The rate of MDRB acquisition in matched SAH patients was 18/1000 patient-days. When compared to SAH retrospective cohort, being admitted to a COVID-19 ICU was associated with a numerically higher proportion of MDRB acquisition. This association did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93-3.21).Conclusion: Acquisition of MDRB was frequent during the COVID-19 first wave in ICU patients. Despite physical isolation, it was similar to patients admitted to the same ICU in previous years.

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Relationship between immunosuppression and intensive care unit-acquired multidrug-resistant bacteria: A case-control study*

Critical Care Medicine ◽

10.1097/01.ccm.0000261885.50604.20 ◽

2007 ◽

Vol 35 (5) ◽

pp. 1318-1323 ◽

Cited By ~ 46

Author(s):

Saad Nseir ◽

Christophe Di Pompeo ◽

Maimouna Diarra ◽

Hélène Brisson ◽

Stéphanie Tissier ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Case Control Study ◽

Multidrug Resistant ◽

Case Control ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Control Study

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Outbreak of Multidrug-Resistant Serratia marcescens Infection in a Neonatal Intensive Care Unit

Infection Control and Hospital Epidemiology ◽

10.1086/587969 ◽

2008 ◽

Vol 29 (5) ◽

pp. 418-423 ◽

Cited By ~ 69

Author(s):

Lisa L. Maragakis ◽

Amy Winkler ◽

Margaret G. Tucker ◽

Sara E. Cosgrove ◽

Tracy Ross ◽

...

Keyword(s):

Intensive Care ◽

Serratia Marcescens ◽

Medical Records ◽

Neonatal Intensive Care ◽

Case Control Study ◽

Multidrug Resistant ◽

Case Control ◽

Outbreak Investigation ◽

Case Identification ◽

Control Study

Background.Serratia marcescens causes healthcare-associated infections and significant morbidity and mortality in neonatal intensive care units (NICUs). We report the investigation and control of an outbreak of multidrug-resistant (MDR) S. marcescens infection at an NICU.Methods.An outbreak investigation and a case-control study were undertaken at a 36-bed NICU in a tertiary care hospital in Baltimore, Maryland, for the period from October 2004 through February 2005. The outbreak investigation included case identification, review of medical records, environmental cultures, patient surveillance cultures, personnel hand cultures, and pulsed-field gel electrophoresis (PFGE). The case-control study included case identification and review of medical records. Infection control measures were implemented. Eighteen NICU neonates had cultures that grew MDR S. marcescens during the study period. The case-control study included 16 patients with the outbreak strain or an unidentified strain of MDR S. marcescens and 32 control patients not infected and/or colonized with MDR S. marcescens, treated in the NICU for at least 48 hours during the study period.Results.PFGE analysis identified a single strain of MDR S. marcescens that infected or colonized 15 patients. Two patients had unique strains, and 1 patient's isolate could not be subtyped. An unrelated MDR S. marcescens isolate was recovered from a sink drain. Exposure to inhalational therapy was an independent risk factor for MDR S. marcescens acquisition after adjusting for birth weight. Extensive investigation failed to reveal a point source for the outbreak.Conclusion.A single epidemic strain of MDR S. marcescens spread rapidly and threatened to become endemic in this NICU. Transient carriage on the hands of healthcare personnel or on respiratory care equipment was the likely mode of transmission. Cohorting patients and staff, at the cost of bed closures and additional personnel, interrupted transmission and halted the outbreak.

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Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study

Antibiotics ◽

10.3390/antibiotics10030302 ◽

2021 ◽

Vol 10 (3) ◽

pp. 302

Author(s):

Giuseppe Migliara ◽

Valentina Baccolini ◽

Claudia Isonne ◽

Sara Cianfanelli ◽

Carolina Di Paolo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Case Control Study ◽

Multidrug Resistant ◽

Case Control ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Nested Case Control ◽

Control Study

Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR Klebsiella pneumoniae (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents.

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Prevalence of Multidrug Resistant Bacteria in Refugees: A Prospective Case Control Study in an Obstetric Cohort

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/s-0043-102579 ◽

2017 ◽

Vol 221 (03) ◽

pp. 132-136 ◽

Cited By ~ 1

Author(s):

Kathrin Oelmeier de Murcia ◽

Birgit Glatz ◽

Stephanie Willems ◽

Annelene Kossow ◽

Marlit Strobel ◽

...

Keyword(s):

Case Control Study ◽

Multidrug Resistant ◽

Case Control ◽

Resistant Bacteria ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Refugee Women ◽

Surveillance Cultures ◽

Control Study ◽

Prospective Case Control Study

Abstract Purpose To determine the prevalence of multidrug resistant (MDR) bacteria in a cohort of pregnant refugee women. Methods In a prospective case control study, surveillance cultures for MDR bacteria (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], MDR Gram-negative bacteria [MRGN]) were analysed between October 2015 and June 2016 from a cohort of 50 pregnant refugee women and 50 resident controls in the obstetric unit of a German tertiary referral hospital. Results Prevalence of MRSA was noticeably higher among refugee women compared to residents (6 vs. 0%). In addition, a trend towards a higher prevalence of VRE and MDR Gram-negative bacteria in refugees was shown (1.8 vs. 0%). Conclusions Due to the higher prevalence of MDR bacteria, surveillance cultures are justified in order to prevent nosocomial spread of MDR bacteria.

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