Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis

The Lancet Microbe, Год журнала: 2023, Номер 4(3), С. e179 - e191

Опубликована: Фев. 1, 2023

BackgroundFrequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed establish the prevalence and predictors bacterial infections resistance COVID-19.MethodsWe did a systematic review meta-analysis studies co-infections (identified within ≤48 h presentation) secondary (>48 after outpatients or hospitalised COVID-19. searched WHO Research Database identify cohort studies, case series, case-control trials, randomised controlled trials populations at least 50 published any language between Jan 1, 2019, Dec 2021. Reviews, editorials, letters, pre-prints, conference proceedings were excluded, as which infection was not microbiologically confirmed (or via nasopharyngeal swab only). screened titles abstracts papers identified by our search, then assessed full text potentially relevant articles. reported pooled doing random-effects meta-regression. Our primary outcomes co-infection infection, antibiotic-resistant pathogens among laboratory-confirmed infections. The study protocol registered PROSPERO (CRD42021297344).FindingsWe included 148 362 976 patients, done December, May, 5·3% (95% CI 3·8–7·4), whereas 18·4% (14·0–23·7). 42 (28%) comprehensive data for Among people infections, proportion that resistant antimicrobials 60·8% 38·6–79·3), isolates 37·5% (26·9–49·5). Heterogeneity organisms substantial (I2=95%).InterpretationAlthough infrequently assessed, is highly prevalent Future research surveillance assessing effect on patient population level are urgently needed.FundingWHO.

Язык: Английский

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Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation

Journal of Infection, Год журнала: 2022, Номер 85(1), С. 57 - 63

Опубликована: Май 21, 2022

To determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients, impact dexamethasone as standard therapy.This multicentre, observational, retrospective study included patients ≥ 18 years admitted from March 1st 2020 to January 31st 2021 with infection who received mechanical ventilation. Patient characteristics, clinical therapy survival were examined.155/156 (115 men, mean age 62 years, range 26-84 years) included. 67 (43%) had 90 superinfections, pneumonia dominated (78%). Superinfections associated receiving (66% vs 32%, p<0.0001), autoimmune disease (18% 5.7%, p<0.016) longer ICU stays (26 17 days, p<0,001). Invasive fungal infections reported exclusively dexamethasone-treated [8/67 (12%) 0/88 (0%), p<0.0001]. Unadjusted 90-day did not differ between or without (64% 73%, p=0.25), but was lower versus (58% 78%, p=0.007). In multiple regression analysis, superinfection use [OR 3.7 (1.80-7.61), p<0.001], pre-existing 3.82 (1.13-12.9), p=0.031] length stay 1.05 p<0.001].In critically ill care strongly independently superinfections.

Язык: Английский

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Rapid expansion and extinction of antibiotic resistance mutations during treatment of acute bacterial respiratory infections

Nature Communications, Год журнала: 2022, Номер 13(1)

Опубликована: Март 9, 2022

Abstract Acute bacterial infections are often treated empirically, with the choice of antibiotic therapy updated during treatment. The effects such rapid switching on evolution resistance in individual patients poorly understood. Here we find that low-frequency mutations emerge, contract, and even go to extinction within days changes therapy. We analyzed Pseudomonas aeruginosa populations sputum samples collected serially from 7 mechanically ventilated at onset respiratory infection. Combining short- long-read sequencing phenotyping 420 isolates revealed while new near-clonal, reflecting a recent colonization bottleneck, could emerge low frequencies then measured vivo select intact resistance-targeted deep amplicon (RETRA-Seq), which rare not detected by clinically used culture-based methods can increase nearly 40-fold over 5–12 response changes. Conversely, conferring antibiotics administered diminish extinction. Our results underscore how shapes dynamics short time scales, findings provide possibility for driving early stages infection designing patient-specific cycling strategies informed genomic surveillance.

Язык: Английский

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Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: a propensity-matched cohort study

Critical Care, Год журнала: 2022, Номер 26(1)

Опубликована: Июнь 13, 2022

To assess the impact of treatment with steroids on incidence and outcome ventilator-associated pneumonia (VAP) in mechanically ventilated COVID-19 patients.Propensity-matched retrospective cohort study from February 24 to December 31, 2020, 4 dedicated Intensive Care Units (ICU) Lombardy (Italy).Adult consecutive patients were subdivided into two groups: (1) treated low-dose corticosteroids (dexamethasone 6 mg/day intravenous for 10 days) (DEXA+); (2) not (DEXA-). A propensity score matching procedure (1:1 ratio) identified patients' cohorts based on: age, weight, PEEP Level, PaO2/FiO2 ratio, non-respiratory Sequential Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), C reactive protein plasma concentration at admission, sex admission hospital (exact matching).Dexamethasone days admission.Seven hundred thirty-nine included, propensity-score groups 158 subjects each. Eighty-nine (56%) DEXA+ versus 55 (34%) DEXA- developed a VAP (RR 1.61 (1.26-2.098), p = 0.0001), after similar time hospitalization, ICU intubation. had higher crude rate (49.58 (49.26-49.91) vs. 31.65 (31.38-31.91)VAP*1000/pd), (IRR 1.57 (1.55-1.58), < 0.0001) risk (HR 1.81 (1.31-2.50), 0.0003), longer LOS invasive mechanical ventilation but mortality 1.17 (0.85-1.63), 0.3332). VAPs similarly due G+ bacteria (mostly Staphylococcus aureus) G- Enterobacterales). Forty-one (28%) multi-drug resistant bacteria. was associated almost doubled ventilation, increased 1.64 [1.02-2.65], 0.040) no differences among groups.Critically ill are high VAP, frequently caused by multidrug-resistant bacteria, is corticosteroid treatment.NCT04388670, retrospectively registered May 14, 2020.

Язык: Английский

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Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

Journal of Clinical Medicine, Год журнала: 2023, Номер 12(4), С. 1298 - 1298

Опубликована: Фев. 6, 2023

Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and determinants that potentially affect are poorly evaluated. We assessed prognosis VAP in severe cases relapse, superinfection, treatment failure on 60-day mortality. Methods: evaluated a multicenter prospective cohort included adult patients with COVID-19, who required mechanical ventilation ≥48 h between March 2020 June 2021. investigated risk factors 30-day mortality, associated failure. Results: Among 1424 admitted to eleven centers, 540 were invasively ventilated 48 or more, 231 had episodes, which caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), S. aureus (22%). The rate was 45.6/1000 ventilator days, cumulative at Day 30 60%. increased duration without modifying crude death (47.6% vs. 44.7% VAP) resulted 36% increase hazard. Late-onset represented 179 episodes (78.2%) responsible 56% rates relapse superinfection 45% 39.5%, respectively, but did not Superinfection more frequently related ECMO first episode non-fermenting bacteria. an absence highly susceptible microorganisms vasopressor need onset. Conclusions: VAP, mainly late-onset death, similar observed other mechanically due difficult-to-treat microorganisms, pharmacokinetic alterations induced renal replacement therapy, shock, likely explains

Язык: Английский

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Association Between Type of Immunosuppression and the Incidence, Microbiology, and Outcomes of Bacterial Ventilator-Associated Lower Respiratory Tract Infections: A Retrospective Multicenter Study

Critical Care Medicine, Год журнала: 2025, Номер unknown

Опубликована: Фев. 21, 2025

Objectives: Ventilator-associated lower respiratory tract infections (VALRTIs) are among the most common ICU-acquired in patients receiving invasive mechanical ventilation (IMV). Immunocompromised may have a incidence of VALRTI when compared with nonimmunocompromised patients, but influence type immunosuppression on epidemiology has not been investigated. The study objectives were to assess association incidence, microbiology, and outcomes (ICU mortality, ICU length stay, duration IMV) related bacterial pathogens. Design: Multicenter, international retrospective cohort study. Setting: One hundred eighteen ICUs (118) nine countries. Patients: Eight fifty-four immunocompromised adult (median age, 65 yr; 57.6% males) requiring IMV for greater than 48 hours, including 162 hematologic malignancies. Interventions: None. Measurements Main Results: Patients malignancies had 28-day cumulative other types (13.6% vs. 20.1%; adjusted cause-specific hazard ratio, 0.61; 95% CI, 0.37–0.97), mostly due ventilator-associated pneumonia (9.3% 13.9%). proportion cases multidrug-resistant bacteria was similar between groups. Occurrence associated an increased mortality longer this effect independent immunosuppression. Conclusions: immunosuppression, mainly pneumonia.

Язык: Английский

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Early steroids and ventilator-associated pneumonia in COVID-19-related ARDS

Critical Care, Год журнала: 2022, Номер 26(1)

Опубликована: Авг. 2, 2022

Abstract Rationale Early corticosteroid treatment is used to treat COVID-19-related acute respiratory distress syndrome (ARDS). Infection a well-documented adverse effect of therapy. Objectives To determine whether early therapy COVID-19 ARDS was associated with ventilator-associated pneumonia (VAP). Methods We retrospectively included adults COVID-19-ARDS requiring invasive mechanical ventilation (MV) for ≥ 48 h at any 15 intensive care units in 2020. divided the patients into two groups based on they did or not receive corticosteroids within 24 h. The primary outcome VAP incidence, death and extubation as competing events. Secondary outcomes were day 90-mortality, MV duration, other organ dysfunctions, characteristics. Measurements main results Of 670 (mean age, 65 years), 369 301 corticosteroids. cumulative incidence higher (adjusted hazard ratio [aHR] 1.29; 95% confidence interval [95% CI] 1.05–1.58; P = 0.016). Antibiotic resistance bacteria different between (odds 0.94, CI 0.58–1.53; 0.81). 90-day mortality 30.9% 24.3% without corticosteroids, nonsignificant difference after adjustment SOFA score, occurrence (aHR 1.15; 0.83–1.60; 0.411). 1.86; 1.33–2.61; 0.0003). Conclusions COVID-19-ARDS. Although mortality, not. Longitudinal randomized controlled trials are warranted.

Язык: Английский

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Epidemiology, risk factors and prognosis of ventilator-associated pneumonia during severe COVID-19: Multicenter observational study across 149 European Intensive Care Units

Anaesthesia Critical Care & Pain Medicine, Год журнала: 2022, Номер 42(1), С. 101184 - 101184

Опубликована: Дек. 9, 2022

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Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review

Biomedicines, Год журнала: 2022, Номер 10(6), С. 1226 - 1226

Опубликована: Май 24, 2022

Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents VAP and resistance to antibiotics in COVID-19 patients. We searched Cochrane Central Register Controlled Trials (CENTRAL), PubMed/MEDLINE, LILACS databases from December 2021. Studies that described frequency pathogens associated their antibiotic patterns critically ill adult patients were included. The Newcastle-Ottawa Quality Assessment Scale was used for critical appraisal. data are presented according number or proportions reported studies. A total 25 articles included, involving 2766 cases (range 5-550 cases). Most studies included carried out France (32%), Italy (20%), Spain (12%) United States (8%). Gram-negative bacteria most frequent incidences studies: P. aeruginosa 7.5-72.5%, K. pneumoniae 6.9-43.7%, E. cloacae 1.6-20% A. baumannii 1.2-20%). S. aureus Gram-positive pathogen, a range incidence 3.3-57.9%. median Aspergillus spp. 6.4%. Few recorded susceptibility among mainly extended-spectrum beta-lactamase (ESBL), AmpC, carbapenem resistance. methicillin isolates 44.4%. Our study provides first comprehensive description VAP. common causing Data published medical literature limited, as well about low- middle-income countries.

Язык: Английский

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Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Annals of Intensive Care, Год журнала: 2021, Номер 11(1)

Опубликована: Дек. 1, 2021

Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors outcome BSI in critically ill infectious disease-19 (COVID-19) patients.We performed an ancillary analysis multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For present analysis, only those primary (death within 90 days from admission) or status were included. Risk for analyzed using Fine Gray competing model. Then, comparison, 537 BSI-patients matched controls propensity score matching.Among patients, 780 (19.5%) total 1066 (10.3 per 1000 patients at risk) whom 92% ICU. Higher SAPS II, male gender, longer time admission antiviral drug before independently associated increased BSI, interestingly, this decreased over time. was shorter death overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05-1.56) and, set, had higher mortality rate (39% vs 33% p = 0.036). accounted 3.6% population.COVID-19 especially early after admission, increases severity but not corticosteroids use. is rate.

Язык: Английский

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