AUTHOR=Monaco Monica , Floridia Marco , Giuliano Marina , Palmieri Luigi , Lo Noce Cinzia , Pantosti Annalisa , Palamara Anna Teresa , Brusaferro Silvio , Onder Graziano , The Italian National Institute of Health COVID-19 Mortality Group , Palmieri Luigi , Agazio Elvira , Barbariol Pierfrancesco , Bella Antonino , Benelli Eva , Bertinato Luigi , Bocci Matilde , Boros Stefano , Bressi Marco , Calcagnini Giovanni , Censi Federica , Ciervo Alessandra , Colaizzo Elisa , Damiano Cecilia , Del Manso Martina , Di Benedetto Corrado , Donfrancesco Chiara , Fabiani Massimo , Facchiano Francesco , Floridia Marco , Galati Fabio , Giuliano Marina , Grisetti Tiziana , Guastadisegni Cecilia , Lo Noce Cinzia , Maiozzi Pietro , Manno Valerio , Martini Margherita , Mateo Urdiales Alberto , Mattei Eugenio , Meduri Claudia , Meli Paola , Minelli Giada , Onder Graziano , Petrone Daniele , Pezzotti Patrizio , Pricci Flavia , Punzo Ornella , Riccardo Flavia , Sacco Chiara , Salerno Paolo , Serra Debora , Spuri Matteo , Tallon Marco , Tamburo De Bella Manuela , Tiple Dorina , Unim Brigid , Vaianella Luana , Fenicia Vescio Maria , Elena Weimer Liliana , Brusaferro Silvio TITLE=Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021) JOURNAL=Frontiers in Medicine VOLUME=9 YEAR=2022 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1041668 DOI=10.3389/fmed.2022.1041668 ISSN=2296-858X ABSTRACT=Introduction

In hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance.

Methods

Hospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses.

Results

The study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018).

Conclusions

In patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.