engleski

Multidrug-resistant bacteria in COVID-19 hospital in Zagreb

During November to December 2020 a high rate of COVID-19 associated pneumonia complicated with bacterial superinfections due to multidrug- resistant (MDR) or extensively drug resistant (XDR) was recorded in COVID-19 hospital in Zagreb. This initiated a study analyzing the causative agents of bacterial superinfections among patients with serious forms of COVID-19. During November to December 2020 a high rate of COVID-19 associated pneumonia complicated with bacterial superinfections due to multidrug- resistant (MDR) or extensively drug resistant (XDR) was recorded in COVID-19 hospital in Zagreb. This initiated a study analyzing the causative agents of bacterial superinfections among patients with serious forms of COVID-19. The effect of acquisition of resistant strain on the duration of hospital stay, risk of VAP and ARDS development and mortality was determined. The rate of the patients having MDR/XDR against total number of hospitalized patients in ICU, was 41% (n=49). The total rate of MDR/XDR pathogens among the total number of isolates obtained in this ICU was 76% (n=49). The dominant species was Acinetobacter baumannii with all isolates (34) being carbapenem resistant (CRAB) and positive for carbapenem-hydrolyzing oxacillinases (CHDL) belonging to OXA-23-like and OXA-24/40-like groups. The isolates were uniformly resistant to ceftazdime, cefepime, imipenem, meropenem, gentamicin, amikacin and ciprofloxacin, but remained susceptibile to colistin. Seven Enterobacteriaceae (four K. pneumoniae and three E. coli) were MDR/XDR. Three K. pneumoniae and E. coli, respectively, harboured blaESBL genes identified by PCR as CTX-M-15. OXA-48 was detected in three K. pneumoniae isolates which demonstrated resistance to colistin as well. Among Gram- positive MDR pathogens, six methicillin- resistant Staphylococcus aureus (MRSA) and two vancomycin- resistant Enterococcus faecium (VRE) were found. blaOXA-48 genes were preceded by IS1999 insertion sequence. ISEcp was found upstream of blaCTX-M-15 genes. In conclusion, it appears that the rate of bacterial superinfections and the dominant MDR causative agents depend on the local epidemiology in the particular COVID centers. A. baumannii seems to spread in overcrowded ICU-s with poor infection control measures and lapses in hospital hygiene measures. Croatia belongs to the 15 countries in the world with the highest mortality rate among COVID-19 patients, which could be in part attributable to high incidence of secondary bacterial infections associated with poor outcome.

COVID-19 ; Acinetobacter baumannii ; resistance ; Klebsiella pneumoniae

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