Volume 29, Number 8—August 2023
Research
Multidrug-Resistant Bacterial Colonization and Infections in Large Retrospective Cohort of Mechanically Ventilated COVID-19 Patients1
Table 1
Characteristics of patients admitted to ICU in Milan, Italy, October 2020–May 2021, who had no MDRO isolates within the first 48 hours after admission*
| Characteristics | Total, n = 347 | No-MDR, n = 140 | MDR>48h, n = 207 | MDRCOL>48h, n = 107 | MDRINF>48h, n = 100 |
|---|---|---|---|---|---|
| Demographics |
|||||
| Age, y (range) |
65.0 (59.0–71.0) |
65.5 (59.0–71.0) |
65.0 (59.0–71.0) |
65.0 (60.0–71.0) |
65.0 (58.0–71.0) |
| Sex |
|||||
| M |
252 (72.6) |
102 (72.9) |
150 (72.5) |
73 (69.2) |
77 (77.0) |
| F |
95 (27.4) |
38 (27.1) |
57 (27.5) |
34 (31.8) |
23 (23.0) |
| BMI, kg/m2 (range) |
28.0 (26.0–31.0) |
28.0 (26.0–31.0) |
29.0 (26.0–32.0) |
29.0 (26.0–32.0) |
29.0 (26.0–32.0) |
| Obesity, BMI >30 |
122 (35.2) |
45 (32.1) |
77 (37.2) |
35 (32.7) |
42 (42.0) |
| Ever smoker† |
66 (19.0) |
29 (20.7) |
37 (17.9) |
11(10.3) |
26 (26.0) |
| Concurrent conditions |
|||||
| Hypertension |
181 (52.2) |
67 (47.9) |
114 (55.0) |
58 (54.2) |
56 (56.0) |
| Cardiovascular disease |
92 (26.6) |
38 (27.1) |
54 (26.2) |
34 (31.8) |
20 (20.0) |
| Pneumopathy |
48 (13.8) |
20 (14.3) |
28 (13.5) |
12 (11.2) |
16 (16.0) |
| Neuropathy |
14 (4.0) |
8 (5.7) |
6 (2.9) |
4 (3.7) |
2 (2.0) |
| Diabetes |
69 (19.9) |
32 (22.9) |
37 (17.9) |
21 (19.6) |
16 (16.0) |
| Immunologic deficits‡ |
22 (6.3) |
9 (6.4) |
13 (6.3) |
9 (8.4) |
4 (4.0) |
| No. concurrent conditions |
|||||
| 0 |
66 (19.0) |
26 (18.6) |
40 (19.3) |
22 (20.6) |
18 (18.0) |
| 1 |
115 (33.1) |
50 (35.7) |
65 (31.4) |
30 (28.0) |
35 (35.0) |
| 2 |
87 (25.1) |
31 (22.1) |
55 (27.0) |
27 (25.2) |
29 (29.0) |
| >3 |
79 (22.3) |
33 (23.6) |
46 (22.2) |
28 (26.2) |
18 (18.0) |
| Setting characteristics |
|||||
| Month of ICU admission |
|||||
| Oct 2020 |
18 (5.2) |
6 (4.3) |
12 (5.8) |
8 (7.5) |
4 (4.0) |
| Nov 2020 |
76 (21.9) |
33 (23.6) |
43 (20.8) |
19 (17.8) |
24 (24.0) |
| Dec 2020 |
34 (9.8) |
13 (9,3) |
21 (10.1) |
9 (8.4) |
12 (12.0) |
| Jan 2021 |
48 (13.8) |
14 (10.0) |
34 (16.4) |
17 (15.9) |
17 (17.0) |
| Feb 2021 |
41 (11.8) |
21 (15.0) |
20 (9.7) |
14 (13.1) |
6 (6.0) |
| Mar 2021 |
64 (18.4) |
25 (17.9) |
39 (18.4) |
24 (22.4) |
15 (15.0) |
| Apr 2021 |
54 (15.6) |
21 (15.0) |
33 (15.9) |
13 (12.2.) |
20 (20.0) |
| May 2021 |
12 (3.5) |
7 (5.0) |
5 (2.4) |
3 (2.8) |
2 (2.0) |
| Setting of provenance |
|||||
| ED |
102 (29.4) |
47 (33.6) |
55 (26.6) |
32 (29.9) |
23 (23.0) |
| Nonintensive hospital wards |
159 (45.8) |
67 (47.9) |
92 (44.4) |
44 (41.1) |
48 (48.0) |
| ICU |
86 (24.8) |
26 (18.6) |
60 (29.0) |
31 (29.0) |
29 (29.0) |
| Hospital center |
|||||
| A |
47 (13.5) |
16 (11.4) |
31 (15.0) |
16 (15.0) |
15 (15.0) |
| B |
28 (8.1) |
12 (8.6) |
16 (7.7) |
11 (10.3) |
5 (5.0) |
| C |
30 (8.7) |
11 (7.9) |
19 (9.2) |
6 (5.6) |
13 (13.0) |
| D |
22 (6.3) |
4 (2.9) |
18 (8.7) |
7 (6.5) |
11 (11.0) |
| E |
27 (27.8) |
10 (7.1) |
17 (8.2) |
10 (9.4) |
7 (7.0) |
| F |
22 (6.3) |
8 (5.7) |
14 (6.8) |
7 (6.5) |
7 (7.0) |
| G |
11 (3.2) |
4 (2.9) |
7 (3.4) |
2 (1.9) |
5 (5.0) |
| H |
16 (4.6) |
6 (4.3) |
10 (4.8) |
4 (3.7) |
6 (6.0) |
| I |
13 (3.6) |
7 (5.0) |
6 (2.9) |
3 (2.8) |
3 (3.0) |
| J |
13 (3.8) |
6 (4.3) |
7 (3.4) |
6 (5.6) |
1 (1.0) |
| K |
8 (2.3) |
4 (2.9) |
4 (1.9) |
2 (1.9) |
2 (2.0) |
| Other |
109 (31.4) |
52 (37.1) |
57 (27.5) |
32 (29.9) |
25 (25.0) |
| Disease characteristics before ICU admission |
|||||
| Days from first symptoms to hospitalization (range) |
5.0 (3.0–7.0) |
6.0 (3.0–8.0) |
5.0 (3.0–7.0) |
9.0 (3.0–7.0) |
5.0 (3.0–7.0) |
| Days from hospitalization to ICU admission (range) |
5.0 (2.0–8.0) |
4.0 (2.0–8.0) |
5.0 (2.0–9.0) |
5.0 (2.0–8.0) |
5.0 (3.0–9.0) |
| Days from hospitalization to MV start (range) |
3.0 (1.0–6.0) |
3.0 (1.0–6.0) |
3.0 (1.0–7.0) |
5.0 (1.0–6.0) |
4.0 (1.0–7.0) |
| Steroid therapy§ |
252 (72.6) |
98 (70.0) |
154 (74.4) |
79 (73.8) |
75 (75.0) |
| Standard dose |
228 (65.7) |
85 (60.8) |
143 (69.0) |
75 (70.1) |
68 (68.0) |
| High dose |
39 (11.3) |
21 (15.0) |
18 (8.7) |
9 (8.4) |
9 (9.0) |
| Antimicrobial drug therapy |
|||||
| None |
126 (36.3) |
48 (34.3) |
78 (37.7) |
45 (42.1) |
33 (33.0) |
| 1 class |
125 (36.0) |
44 (31.4) |
81 (39.1) |
39 (36.5) |
42 )42.0) |
| 2 classes |
73 (21.0) |
39 (27.9) |
34 (16.4) |
14 (13.1) |
20 (20.0) |
| >3 classes |
23 (6.6) |
9 (6.4) |
14 (6.8) |
9 )8.4) |
5 (5.0) |
| MDRO infection/colonization |
4 (1.2) |
2 (1.4) |
2 (1.0) |
2 (1.9) |
0 |
| PaO2:FIO2 ratio at ICU admission, mm Hg (range) |
137 (106.0–180.0) |
130.5 (100.5–176.5) |
138.0 (110.0–180.0) |
147.0 (111.0–184.0) |
127.5 (109.0–177.5) |
| 200 |
56 (16.7) |
22 (15.7) |
36 (17.4) |
19 (17.8) |
17 (17.0) |
| <100 and >200 |
218 (62.8) |
83 (59.3) |
135 (65.2) |
73 (68.2) |
62 (62.0) |
| <100 |
71 (20.4) |
35 (25.0) |
36 (17.4) |
15 (14.0) |
21 (21.0) |
| Outcome |
|||||
| Alive at discharge |
229 (66.0) |
93 (66.4) |
136 (65.7) |
74 (69.2) |
62 (62.0) |
| Deceased |
118 (34.0) |
47 (33.6) |
71 (34.3) |
33 (30.8) |
38 (38.0) |
| Length of MV, d (range)¶# |
16.0 (10.0–26.0) |
14.0 (8.0–21.0) |
18.0 (12.0–29.0) |
16.5 (11.0–26.0) |
20.0 (12.0–30.0) |
| ICU stay, d (range)** | 21.0 (13.0–33.0) | 15.5 (10.0–24.0) | 25.0 (16.0–37.0) | 20.0 (12.0–30.0) | 29.0 (21.0–42.0) |
*Values are no. (%) except as indicated. Patients who had MDRO events during ICU stay (MDR>48h) are reported globally and divided between those who had >1 MDRO infection (MDRINF>48h) and those with MDRO colonization only (MDRCOL>48h). Comparisons are made between no-MDR and MDR>48h groups and between MDRINF>48h and MDRCOL>48h groups. Categorical variables are expressed as frequency (percentages), continuous variables are expressed as median (interquartile range). BMI, body mass index; ED, emergency department; ICU, intensive care unit; MDRO, multidrug resistant organism. MV, mechanical ventilation; Other, 36 centers that had <10 patients. †MDRCOL>48h versus MDRINF>48h. p value = 0.003 by χ2 test. ‡At least 1 of solid organ transplantation, active neoplastic disease, hematologic disease, rheumatologic disease, AIDS, asplenia, chemotherapy in the past 3 mo of neutropenia (n<50 cells/μL), use of biologics, use of corticosteroids (>10 mg/day prednisone or equivalent >3 mo prehospitalization), other forms of immunosuppression (including congenital/genetic forms). §Standard dose in case of use of dexamethasone or methylprednisolone <1 mg/kg/d, high dose in case of use of methylprednisolone >1 mg/kg/d or equivalent (patients could have received both standard and high dose of steroid). ¶No-MDR versus MDR>48h. p = 0.001 by Mann–Whitney U test. #MDRCOL>48h versus MDRINF>48h. , p = 0.001 by Mann–Whitney U test. **No-MDR versus MDR>48h. p = 0.001 by Mann–Whitney U test.
1Preliminary results were presented at the European Congress of Clinical Microbiology and Infectious Diseases, 2022, Lisbon, Portugal, April 23‒26, 2022 (abstract no. 02641).
2These senior authors contributed equally to this article.
3Study group members are listed at the end of this article.