Infection with the multidrug-resistant Klebsiella pneumoniae New Delhi metallo-B-lactamase strain in patients with COVID-19: Nec Hercules contra plures?

Autor:	Janc J; Department of Anaesthesiology and Intensive Therapy, Hospital of Ministry of the Interior and Administration, Wrocław, Poland., Słabisz N; Department of Microbiology, 4th Military Clinical Hospital, Wrocław, Poland., Woźniak A; Department of Nursing and Midwifery, Wroclaw Medical University, Wrocław, Poland., Łysenko L; Departament of Anaesthesiology and Intensive Care Unit, Wroclaw Medical University, Wrocław, Poland., Chabowski M; Department of Surgery, 4th Military Clinical Hospital, Wrocław, Poland.; Department of Clinical Surgical Sciences, Faculty of Medicine, Wrocław University of Science and Technology, Wrocław, Poland., Leśnik P; Department of Microbiology, Wroclaw Medical University, Wrocław, Poland.
Jazyk:	angličtina
Zdroj:	Frontiers in cellular and infection microbiology [Front Cell Infect Microbiol] 2024 Apr 16; Vol. 14, pp. 1297312. Date of Electronic Publication: 2024 Apr 16 (Print Publication: 2024).
DOI:	10.3389/fcimb.2024.1297312
Abstrakt:	Background: During the coronavirus disease 2019 (COVID-19) pandemic, in patients treated for SARS-CoV-2 infection, infections with the Klebsiella pneumoniae bacteria producing New Delhi metallo-B-lactamase (NDM) carbapenemase in the USA, Brazil, Mexico, and Italy were observed, especially in intensive care units (ICUs). This study aimed to assess the impact of Klebsiella pneumoniae NDM infection and other bacterial infections on mortality in patients treated in ICUs due to COVID-19. Methods: The 160 patients who qualified for the study were hospitalized in ICUs due to COVID-19. Three groups were distinguished: patients with COVID-19 infection only (N = 72), patients with COVID-19 infection and infection caused by Klebsiella pneumoniae NDM (N = 30), and patients with COVID-19 infection and infection of bacterial etiology other than Klebsiella pneumoniae NDM (N = 58). Mortality in the groups and chosen demographic data; biochemical parameters analyzed on days 1, 3, 5, and 7; comorbidities; and ICU scores were analyzed. Results: Bacterial infection, including with Klebsiella pneumoniae NDM type, did not elevate mortality rates. In the group of patients who survived the acute phase of COVID-19 the prolonged survival time was demonstrated: the median overall survival time was 13 days in the NDM bacterial infection group, 14 days in the other bacterial infection group, and 7 days in the COVID-19 only group. Comparing the COVID-19 with NDM infection and COVID-19 only groups, the adjusted model estimated a statistically significant hazard ratio of 0.28 (p = 0.002). Multivariate analysis revealed that age, APACHE II score, and CRP were predictors of mortality in all the patient groups. Conclusion: In patients treated for SARS-CoV-2 infection acquiring a bacterial infection due to prolonged hospitalization associated with the treatment of COVID-19 did not elevate mortality rates. The data suggests that in severe COVID-19 patients who survived beyond the first week of hospitalization, bacterial infections, particularly Klebsiella pneumoniae NDM, do not significantly impact mortality. Multivariate analysis revealed that age, APACHE II score, and CRP were predictors of mortality in all the patient groups. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Janc, Słabisz, Woźniak, Łysenko, Chabowski and Leśnik.)
Databáze:	MEDLINE
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