• Clinics · Jan 2022

    The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with COVID-19.

    • Viviane de Macedo, Gabriela de Souza Dos Santos, Rodolff Nunes da Silva, Caio Nogara de Menezes Couto, Camila Bastos, Eloize Viecelli, Marina do Nascimento Mateus, Maria Esther Graf, Raquel Bernardelli Gonçalves, Márcia Aparecida da Silva, Patricia Dal Bem Bernardini, Roberta Serra Pereira Grando, Viviane Pavanelo Boaventura, Helki Simone Rodrigues Pereira, and Anna S Levin.
    • Hospital Infection Control and Epidemiology Center, Santa Casa de Curitiba, Curitiba, PR, Brazil; Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. Electronic address: vioakmac@gmail.com.
    • Clinics (Sao Paulo). 2022 Jan 1; 77: 100130100130.

    BackgroundThe relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU).MethodsThis is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done.ResultsSixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009).ConclusionsMale gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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