Clinical characteristics and risk factors for the isolation of multidrug-resistant Gram-negative bacteria from critically ill patients with Coronavirus Disease 2019

Baiou, Anas; Elbuzidi, Abdurrahman A.; Bakdach, Dana; Zaqout, Ahmed; Alarbi, Khalid M.; Bintaher, Awadh A.; Ali, Maisa M.B.; Elarabi, Anam M.; Ali, Gawahir A.M.; Daghfal, Joanne; Almaslamani, Muna A.; Ibrahim, Abdul Salam S.; Alkhal, Abdullatif; Omrani, Ali S.

BACKGROUND: We investigated the clinical characteristics and risk factors for the isolation of multidrug resistant (MDR) Gram-negative bacteria (GNB) from critically ill COVID-19 patients. METHODS: We retrospectively matched (1:2) critical COVID-19 patients with one or more MDR GNB from any clinical specimen (cases), with those with no MDR GNB isolates (controls). RESULTS: Seventy-eight cases were identified (4.5 per 1,000 ICU days, 95% confidence interval [CI] 3.6–5.7). Out of 98 MDR GNB isolates, the most frequent species were Stenotrophomonas maltophilia (24, 24.5%), and Klebsiella pneumoniae (23, 23.5%). Two (8.7%) K. pneumoniae, and six (85.7%) Pseudomonas aeruginosa isolates were carbapenem resistant. A total of 24 (24.5%) isolates were not considered to be associated with active infection. Those with active infection received appropriate antimicrobial agent within a median of one day. The case group had significantly longer median central venous line days, mechanical ventilation days, and hospital length of stay (P<0.001 for each). All-cause mortality at 28 days was not significantly different between the two groups (P = 0.19). Mechanical ventilation days (adjusted odds ratio [aOR] 1.062, 95% CI 1.012 to 1.114; P 0.015), but not receipt of corticosteroids or tocilizumab, was independently associated with the isolation of MDR GNB. There was no association between MDR GNB and 28-day all-cause mortality (aOR 2.426, 95% CI 0.833 to 7.069; P = 0.104). CONCLUSION: In critically ill COVID-19 patients, prevention of MDR GNB colonization and infections requires minimising the use of invasive devices, and to remove them as soon as their presence is no longer necessary.