Volume 29, Number 8—August 2023
Research
Multidrug-Resistant Bacterial Colonization and Infections in Large Retrospective Cohort of Mechanically Ventilated COVID-19 Patients1
Table 3
Characteristics of 18 studies on MDRO colonization and infections in critically ill patients who had COVID-19, Italy*
| Year (ref) | Study design |
Country |
Period |
No. ICU COVID-19 patients |
MV patients, no. (%) |
Median age, y (Q1‒Q3) |
Type of MDRO event |
MDRO events proportion and measures of incidence |
Median days to MDRO event from ICU admission (Q1‒Q3) |
Etiology of MDRO colonization/infection† |
Source of MDRO infection/colonization |
Notes |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2021 (4) |
Multicentric retrospective study |
Italy |
2020 Feb‒2020 May |
774 |
688 (89) |
62 (54–68) |
Infection |
Pr MDRO: 272/723 (38%) infections; CI: N/A (359 patients with infections); IR: NA |
14 (7–23) |
GPB 138/272 (51%); 138/317 (43.5%) within species; Staphylococcus aureus 83/272 (31%); 83/151 (55%) within species; Enterococcus spp. 29/272 (11%); 29/117 (24.8%) within species; CoNS 24/272 (9%); 24/30 (80%) within species; GNB 133/272 (49%); 133/406 (32.7%) within species
Pseudomonas aeruginosa 34/272 (12%); 34/119 (28.6%) within species; Enterobacterales (other) 29/272 (11%); 29/101 (28.7%) within species; Klebsiella spp. 25/272 (9%); 25/63 (39.7%) within species; Escherichia coli 18/272 (7%); 18/54 (33.3%) within species; Acinetobacter baumannii 19/272 (7%); 19/21 (90.5%) within species |
NA |
||||||||||||||
| 2021 (5) |
Monocentric retrospective study |
Spain |
3/2020‒6/2020 |
213 |
184 (86) |
61 (54–68) |
Infection |
Pr MDRO: 51/174 (29%) infections; CI: 37/213 (17%) patients; IR: NA |
28 (13–49) |
GPB 10/51 (19.6%); S. aureus 3/51 (5.9%); Enterococcus faecium 2/51 (3.9%); CoNS 5/51 (9.8%); GNB 41/51 (80.4%); 41/65 (63.5%) within species; Pseudomonas aeruginosa 11/51 (21.6%); 11/22 (50%) within species; Klebsiella spp. 10/10 (100%) within species |
NA |
||||||||||||||
| 2021 (6) |
Monocentric retrospective study |
Italy |
3/2020‒5/2020 |
32 |
NA |
68 (55.2–75) |
Infection |
Pr MDRO: NA; CI: 16/32 (50%) patients; IR: NA |
8 |
Staphylococcus aureus 1/23 (4%); Enterococcus faecium 2/23 (9%); Enterococcus faecalis 1/23 (4%); Stenotrophomonas maltophilia 2/23 (9%); Enterobacter spp. 2/23 (9%); Pseudomonas aeruginosa 3/23 (14%); Klebsiella pneumoniae 8/23 (32%); Acinetobacter baumannii 4/23 (19%) |
Respiratory 2/16 (12.5%); respiratory plus blood 8/16 (50%); blood 2/16 (12.5%); respiratory, urine, and blood 4/16 (25%) |
||||||||||||||
| 2021 (7) |
Monocentric retrospective study |
India |
7/2020‒12/2021 |
750 |
516 (69) |
62 (51–72) |
Infection
(BSI only) |
Pr MDRO: NA; CI: 37/750 (5%) patients; IR: NA |
NA |
Acinetobacter baumannii 3/21 (33%) within species; Klebsiella pneumoniae 11/14 (78.6%) within species; Escherichia coli 6/7 (85.7%) within species; Pseudomonas aeruginosa 0/4 (0%) within species |
Blood 100%, due to MDRO in 37/64 (57.8%) |
||||||||||||||
| 2021 (8) |
Multicentric retrospective study |
Qatar |
3/2020‒8/2020 |
234 |
NA |
49 (40–60) |
Infection and colonization (GNB only) |
Pr MDRO: NA; CI: 78/234 (33%) patients; IR: 4.5/1,000 pt-days |
9 (4–14) |
Infection: tenotrophomonas maltophilia 24/98 (24.5%); Klebsiella pneumoniae 23/98 (23.5%); Enterobacter cloacae 18/98 (18.4%); Escherichia coli 12/98 (12%); Serratia marcescens 12/98 (12%); Pseudomonas aeruginosa 8/98 (7.7%); Colonization: Stenotrophomonas maltophilia 24/98 (24.5%); Klebsiella pneumoniae 23/98 (23.5%); Enterobacter cloacae 18/98 (18.4%); Escherichia coli 12/98 (12%); Serratia marcescens 12/98 (12%); Pseudomonas aeruginosa 8/98 (7.7%) |
Respiratory 74/98 (75.5%); blood 18/98 (18.4%); urine 6/98 (6.1%) |
No distinction between colonization and infection |
|||||||||||||
| 2020 (9) |
Monocentric retrospective study |
Belgium |
3/2020‒4/2020 |
75 |
52 (72) |
61 (9)
[mean (SD)] |
Infection and colonization |
Pr MDRO: NA; CI: 24/72 (33%) patients; IR: 30/1,000 pt-days |
12 (8–18) |
Enterococcus faecium 3/31 (10%); Enterobacter spp. 13/31 (42%) Klebsiella pneumoniae 8/31 (26%); Escherichia coli 3/31 (10%); Pseudomonas aeruginosa 4/31 (13%) |
NA |
No distinction between colonization and infection; Mechanisms of resistance (Enterobacterales): AmpC 12/31 (39%); ESBL 9/31 (29%); CRE 3/31 (10%) |
|||||||||||||
| 2021 (10) |
Monocentric retrospective study |
Spain |
3/2020‒5/2020 |
24‡ |
NA |
69.5 (45–72) |
Colonization |
Pr MDRO: NA; CI: 5/24 (21%) patients; IR: NA |
NA |
Klebsiella pneumoniae 3/8 (37.5%); Escherichia coli 2/8 (25%); Stenotrophomonas maltophilia 1/8 (12.5%); Enterobacterales (other) 2/8 (25%) |
NA |
4/24 (17%) patients already colonized at ICU admission |
|||||||||||||
| 2022 (11) |
Before-and-after, cross-sectional retrospective study |
Italy |
1/2020‒4/2020 |
1,151§ |
NA |
65 (54–74) |
Infection and colonization (CPE and CR-Ab only) |
CPE colonization; Pr MDRO: NA; CI: NA; IR: 4.02/1,000 pt-days (0.56/,1000 pt-days in MV subset-125 patients); CPE Pr infection; MDRO: NA; NA; IR: 2.6/1000 pt-days (0.72/1000 pt-days in MV subset); CR-Ab colonization; Pr MDRO: NA; CI: N/; IR: 3.68/1,000 pt-days (1.12/1,000 pt-days in MV subset; CR-Ab infection; Pr MDRO: NA; CI NA; IR: 2.6/1,000 pt-days (0.72/1,000 pt-days in MV subset) |
CR-Ab; events: 17 (11–24) |
NA |
CPE colonization: - rectal 32/35 (91.4%); respiratory 3/35 (8.5%); CPE infection: blood 1/2 (50%); respiratory 1/2 (50%); CR-Ab colonization: rectal 5/32 (15%); respiratory 16/32 (50%); CR-Ab infection: blood 9/23 (39%); respiratory 14/23 (60,8%) |
Only resistance mechanisms were reported (no bacterial species within Enterobacterales). No distinction between colonization and infection in etiology; Mechanisms of resistance: KPC 22/35 (62.8%); OXA-48 6/35 (17.1%)’ VIM 7/35 (20%); NDM 0/35 (0%) |
|||||||||||||
| 2021 (12) |
Monocentric retrospective study |
Italy |
2/2021‒5/2021 |
89 |
89 (100) |
67 (42–83) |
Infection and colonization |
Pr MDRO: 80/164 (49%) events; CI colonization: 11/89 (12%) patients; IR: NA |
14.9 (7–21) |
Infection: GPB 7/40 (17.5%); 7/22 (31.8%) within species; Staphylococcus aureus 4/40 (10%); 4/12 (33.3%) within species; Enterococcus faecalis 2/40 (5%); 2/6 (33.3%) within species; Enterococcus faecium 1/40 (2.5%); 1/2 (50%) within species; GNB 33/40 (82.5%); 33/45 (73.3%) within species; Acinetobacter baumannii 12/40 (30%); 12/12 (100%) within species; Pseudomonas aeruginosa 5/40 (12.5%); 2/4 (50%) within species; Escherichia coli 2/40 (5%); Klebsiella spp. 6/40 (15%); 6/9 (66.7%) within species; Enterobacterales (other) 8/40 (20%); 8/15 (53.3%) within species; Colonization: GPB 12/37 (32.4%); 12/37 (%) within species; Staphylococcus aureus 4/37 (10.8%); 4/17 (23.5%) within species; Enterococcus faecalis 4/37 (10.8%); 4/15 (26.6%) within species; Enterococcus faecium 4/37 (10.8%); 4/5 (80%) within species; GNB 25/37 (67.6%); 25/60 (41.7%) within species; Acinetobacter baumannii 4/37 (10.8%); 4/4 (100%) within species; Pseudomonas aeruginosa 4/37 (10.8%); 4/4 (100%) within species; Escherichia coli 7/37 (18.9%); 7/25 (28%) within species; Klebsiella spp. 2/37 (5.4%); 2/9 (22.2%) within species; Enterobacterales (other) 8/37 (21.6%); 8/18 (44.4%) within species |
Respiratory 48/92 (52.2%), due to MDRO in 31/48 (64.5%); blood in 29/92 (31.5%), due to MDRO in 18/31 (62%); urinary in 15/92 (16.3%), due to MDRO in 5/15 (33.3%) |
No distinction between colonization and infection in etiology and source |
|||||||||||||
| 2022 (13) |
Monocentric retrospective study |
Iran |
3/2020‒9/2020 |
553 |
337 (61) |
69 (21–95) |
Infection |
Pr MDRO: NA; CI: 62/553 (11%) patients; IR: NA |
NA |
Klebsiella pneumoniae 46/83 (55.4%); 46/47 (97.9%) within species; Acinetobacter baumannii 35/83 (42.2%); 35/35 (100%) within species |
Respiratory 62/70 (88.6%) blood in 6/70 (8.6%) |
||||||||||||||
| 2022 (14) |
Monocentric prospective study |
Thailand |
4/2020‒8/2020 |
120 |
48 (40) |
61 (26–87) |
Infection and colonization |
Pr MDRO: NA; CI: 28/120 (23%) patients; IR: NA |
NA |
Infection: Acinetobacter baumannii 21/29 (72.4%); Pseudomonas aeruginosa 2/29 (6.9%); Klebsiella pneumoniae 3/29 (10.3%); Escherichia coli 2/20 (6.9%); Colonization: Acinetobacter baumannii 21/29 (72.4%); Pseudomonas aeruginosa 2/29 (6.9%); Klebsiella pneumoniae 3/29 (10.3%); Escherichia coli 2/20 (6.9%) |
NA |
No distinction between colonization and infection |
|||||||||||||
| 2021 (15) |
Monocentric retrospective study |
Italy |
2/2020‒4/2020 |
89 |
82 (93) |
61.5 (53.1–68.7) |
Infection (BSI only) |
Pr MDRO: 32/117 (27%) infections; CI: NA; IR: NA |
NA |
GPB 10/32 (31.2%); 10/60 (16.7%) within species; Staphylococcus aureus 5/32 (15.6%); 5/7 (71.4%) within species; Enterococcus spp. 5/32 (15.6%); 5/53 (9.4%) within species; GNB 22/32 (68.8%); 22/29 (75.7%) within species; Enterobacter spp. 4/32 (12.5%); 4/6 (66.7%) within species; Enterobacterales (other) 16/32 (50%); 16/19 (84.2%) within species; Pseudomonas aeruginosa 1/32 (3.1%); 1/2 (50%) within species; Stenotrophomonas maltophilia 1/32 (3.1%); 1/1 (100%) within species |
Blood 100%, due to MDRO in 32/85 (37.6%) |
||||||||||||||
| 2022 (16) |
Multicentric retrospective study |
Italy |
2/2020‒12/2020 |
316 |
316 (100) |
62 (54–68) |
Infection (LRTIs only) |
Pr MDRO: 41/144 (28%) infections; CI: 41/316 (13%) patients; IR patients with DEX treatment: 31.48/1,000 pt-days; IR patients without DEX treatment: 27.83/1,000 pt-days |
NA |
GPB 11/41 (27%); 11/48 (22.9%) within species; Staphylococcus aureus 11/41 (27%); 11/40 (27.5%) within species; GNB 30/41 (73%); 30/96 (31.2%) within species; Pseudomonas aeruginosa 12/41 (29%); 12/36 (33.3%) within species; Acinetobacter baumannii 6/41 (15%); 6/6 (100%) within species; Escherichia coli 2/41 (5%); 2/7 (28.6%) within species; Klebsiella pneumoniae 1/41 (2.5%); 1/17 (5.9%) within species; Enterobacterales (others) 6/41 (15%); 6/19 (31.6%) within species |
LRTI 100%, due to MDRO in 41/144 (28%) |
||||||||||||||
| 2022 (17) |
Monocentric retrospective study |
Greece |
4/2020‒12/2020 |
84 |
84 (100) |
70 (57–76) |
Infection(BSI only) |
Pr MDRO: 60/60 (100%) infections; CI: 48/84 (57%) patients; IR: NA |
9 (5–11) |
Acinetobacter baumannii 20/60 (33%); Klebsiella pneumoniae 19/60 (32%); Enterococcus spp. 14/60 (23%); Stenotrophomonas maltophilia 3/60 (5%); Pseudomonas aeruginosa 2/60 (3%);Proteus mirabilis 1/60 (2%); Serratia marcescens 1/60 (2%) |
BSI 100%, due to MDRO in 60/60 (100%) |
||||||||||||||
| 2022 (18) |
Multicentric retrospective study |
Italy |
3/2020‒12/2020 |
123 |
68 (55.3) |
66 (59–75) |
Infection (CRE only) |
Pr MDRO: NA; CI CRE rectal colonization: 80/106 (75%) patients; IR: NA |
16 (10–26) |
Klebsiella pneumoniae 109/123 (88.6%); Enterobacter spp. 10/123 (8.1%); Proteus mirabilis 3/123 (2.4%); Serratia marcescens 1/123 (0.8%) |
Respiratory 28/123 (22.8%); blood 64/123 (52%); urinary 28/123 (22.8%) |
Mechanisms of resistance: KPC 63/123 (51.2%); OXA-48 6/123 (4.9%); VIM 7/123 (5.7%); NDM 47/123 (38.2%) |
|||||||||||||
| 2022 (19) |
Multicentric retrospective study |
USA |
3/2020‒6/2020 |
148 |
148 (100) |
60
[mean] |
Infection (LRTIs only) |
Pr MDRO: 20/50 (40%) infections; CI: 8/132 (6%) patients; IR: NA |
NA |
GPB 6/20 (30%); 6/17 (35.3%) within species; Staphylococcus aureus 6/20 (30%); 6/14 (42.8%) within species; GNB 14/20 (70%); 14/33 (%) within species; Klebsiella spp. 2/20 (10%); 2/10 (20%) within species; Pseudomonas spp. 8/20 (40%); 8/8 (100%) within species; Escherichia coli 1/20 (5%); 1/4 (25%) within species; Stenotrophomonas maltophilia 2/20 (10%); 2/2 (100%) within species; Serratia spp. 1/20 (5%); 1/2 (50%) within species |
Respiratory 100%, due to MDRO in 20/50 (40%) |
||||||||||||||
| 2022 (20) |
Two-center retrospective study |
Turkey |
3/2020‒12/2020 |
146 |
116 (79.5) |
64 (56–72.3) |
Infection (CR GNB only) |
Pr MDRO: 61/104 (59%) infections; CI: 41/146 (28%) patients; IR: NA |
14 |
Acinetobacter spp. 26/61 (42.6%); 26/27 (96.3%) within species; Klebsiella spp. 24/61 (39.3%); 24/26 (92.3%) within species; Pseudomonas aeruginosa 7/61 (11.5%); 7/9 (77.8%) within species |
NA |
||||||||||||||
| 2022 (21) |
Monocentric retrospective study |
India |
8/2020‒12/2020 |
63 |
63 (100) |
62 (12)
[mean (SD)] |
Infection (LRTIs only) |
Pr MDRO: 52/100 (52%) infections; CI: NA; IR: NA |
NA |
Klebsiella pneumoniae 31/52 (56%); Acinetobacter baumannii 8/52 (14%); Burkholderia cepacia 4/52 (7%); Enterobacter cloacae 3/52 (5%); Pseudomonas aeruginosa 1/52 (1.8%); Staphylococcus aureus 1/52 (1.8%) |
Respiratory 100%, due to MDRO in 52/55 (94.5%) |
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*BSI, bloodstream infection; CI, cumulative incidence; CoNS, coagulase-negative Staphylococcus; CPE, carbapenemases-producing Enterobacterales; CRE, carbapenem-resistant Enterobacterales; CR-Ab, carbapenem-resistant Acinetobacter baumannii; CR GNB carbapenem-resistant gram-negative bacteria; DEX, dexamethasone; GNB, gram-negative bacteria; GPB, gram-positive bacteria; IR, incidence rate; LRTI, lower respiratory tract infection; MDRO, multidrug-resistant organism; MV, mechanical ventilation; NA, not available; Pr, proportion; pt-days, patient-days.†MDRO proportion by species (no./total MDRO) and, when available, MDRO proportion within species (no./total species) is reported. ‡Subgroup of the study population of 345 COVID-19 patients and no-COVID patients. §Subgroup of the study population of 2,403 COVID-19 and no-COVID patients.
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.
Page created: June 22, 2023
Page updated: July 20, 2023
Page reviewed: July 20, 2023
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