Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms

Sarah B. Nahhal MD , Johnny Zakhour MD , Abdel Hadi Shmoury MD , Tedy Sawma MD , Sara F. Haddad MD , Tamara Abdallah MSc , Nada Kara Zahreddine CIC , Joseph Tannous MHRM , Nisrine Haddad Pharm D , Nesrine Rizk MD , Souha S. Kanj MD
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Abstract

Objective

To report the microbiological profile of the pathogens implicated in blood stream infections (BSI) in hospitalized coronavirus disease 2019 (COVID-19) patients and to examine the risk factors associated with multidrug-resistant organisms (MDROs) causing BSI.

Patients and Methods

Between March 2020 and September 2021, 1647 patients were hospitalized with COVID-19 at the American University of Beirut. From 85 patients, 299 positive blood cultures were reported to the Infection Control and Prevention Program. The BSI was defined as 1 positive blood culture for bacterial or fungal pathogens. The following organisms were considered MDROs: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp, carbapenem-resistant Enterobacterales spp., carbapenem-resistant Pseudomonas aeruginosa, MDR Acinetobacter baumannii only susceptible to colistin or tigecycline, and Candida auris.

Results

We identified 99 true positive BSI events. Gram-negative bacteria accounted for 38.4 %, followed by Gram-positive bacteria (37.4%), and fungi (24.2%). The most isolated species were Candida spp. (23%), 3 of which were C. auris, followed by Enterobacterales spp. (13%), Enterococcus spp. (12%), S. aureus (9%), P. aeruginosa (9%), and A. baumannii (3%). The MDROs represented 26% of the events. The overall mortality rate was 78%. The time to acquisition of BSI in patients with MDROs was significantly longer compared with that of non-MDROs (20.2 days vs 11.2 days). And there was a significantly shorter time from acquisition of BSI to mortality between MDROs and non-MDROs (1.5 vs 8.3 days).

Conclusion

Rigorous infection prevention and control measures and antimicrobial stewardship are important to prevent antimicrobial resistance progression, especially in low-resource settings.

黎巴嫩某三级医疗中心COVID-19患者的血流感染:致病病原体和多重耐药菌率
目的报告2019冠状病毒病(COVID-19)住院患者血流感染(BSI)病原菌的微生物学特征,探讨多药耐药菌(mdro)引起BSI的相关危险因素。患者和方法在2020年3月至2021年9月期间,贝鲁特美国大学有1647名患者因COVID-19住院。从85名患者中,299例阳性血培养报告给感染控制和预防计划。BSI定义为1个细菌或真菌病原体血培养阳性。以下生物被认为是耐药细菌:耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、耐碳青霉烯肠杆菌、耐碳青霉烯铜绿假单胞菌、耐多药鲍曼不动杆菌仅对粘菌素或替加环素敏感,以及金黄色念珠菌。结果共鉴定出99例BSI真阳性事件。革兰氏阴性菌占38.4%,革兰氏阳性菌占37.4%,真菌占24.2%。检出最多的菌种是念珠菌(23%),其中金黄色葡萄球菌(C. auris) 3种,其次是肠杆菌(13%)、肠球菌(12%)、金黄色葡萄球菌(9%)、铜绿假单胞菌(9%)和鲍曼不动杆菌(3%)。mdro代表了26%的事件。总死亡率为78%。与非mdro患者相比,mdro患者获得BSI的时间明显更长(20.2天vs 11.2天)。mdro和非mdro之间从获得BSI到死亡的时间明显更短(1.5天对8.3天)。结论严格的感染防控措施和抗菌药物管理是防止耐药性发展的重要措施,特别是在资源匮乏地区。
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来源期刊
Mayo Clinic proceedings. Innovations, quality & outcomes
Mayo Clinic proceedings. Innovations, quality & outcomes Surgery, Critical Care and Intensive Care Medicine, Public Health and Health Policy
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