The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19

• Autor(a) principal: Macedo, Viviane de
• Data de Publicação: 2022
• Outros Autores: Santos, Gabriela de Souza dos, Silva, Rodolff Nunes da, Couto, Caio Nogara de Menezes, Bastos, Camila, Viecelli, Eloize, Mateus, Marina do Nascimento, Graf, Maria Esther, Gonçalves, Raquel Bernardelli, Silva, Márcia Aparecida da, Bernardini, Patricia Dal Bem, Grando, Roberta Serra Pereira, Boaventura, Viviane Pavanelo, Pereira, Helki Simone Rodrigues, Levin, Anna S.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Clinics
• Texto Completo: https://www.revistas.usp.br/clinics/article/view/213574
• topic: COVID-19; Antimicrobial resistance; Gram-negative bacteria; Intensive Care Unit; Health Facility

Background: The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU). Methods: This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done. Results: Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009). Conclusions: Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.