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

Autor:	de Macedo V; 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., Dos Santos GS; Hospital Infection Control and Epidemiology Center, Rehabilitation Hospital, Curitiba, PR, Brazil., da Silva RN; Infection Control Program, Hospital de Clínicas, Curitiba, PR, Brazil., Couto CNM; Faculdade de Medicina, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil., Bastos C; Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil., Viecelli E; Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil., Mateus MDN; Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil., Graf ME; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., Gonçalves RB; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., da Silva MA; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., Bernardini PDB; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., Grando RSP; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., Boaventura VP; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., Pereira HSR; Hospital Infection Control and Epidemiology Center, Hospital do Trabalhador, Curitiba, PR, Brazil., Levin AS; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Clinics (Sao Paulo, Brazil) [Clinics (Sao Paulo)] 2022 Oct 17; Vol. 77, pp. 100130. Date of Electronic Publication: 2022 Oct 17 (Print Publication: 2022).
DOI:	10.1016/j.clinsp.2022.100130
Abstrakt:	Background: The 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). Methods: This 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. Results: Sixty-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). Conclusions: Male 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. Competing Interests: Conflicts of interest The authors declare no conflicts of interest. (Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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