Bloodstream Infections in a COVID-19 Non-ICU Department: Microbial Epidemiology, Resistance Profiles and Comparative Analysis of Risk Factors and Patients' Outcome.
Efthymia Giannitsioti, Christina Louka, Vasiliki Mamali, Elisavet Kousouli, Lemonia Velentza, Vaia Papadouli, Georgios Loizos, Panagiotis Mavroudis, Georgios Kranidiotis, Nektaria Rekleiti, Alexandra Stamati, Ioannis Speggos, Ioannis Daniil, Panagiotis Kouvatsos, Chrysanthi Sidiropoulou, Garifallia Linardaki, Styliani Gerakari, Georgios Chrysos, Katina Themeli-Digalaki, Olympia Zarkotou
Author Information
Efthymia Giannitsioti: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Christina Louka: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece.
Vasiliki Mamali: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece.
Elisavet Kousouli: Infection Control Action Team, Tzaneio General Hospital, 18536 Piraeus, Greece.
Lemonia Velentza: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Vaia Papadouli: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece.
Georgios Loizos: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Panagiotis Mavroudis: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Georgios Kranidiotis: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Nektaria Rekleiti: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece.
Alexandra Stamati: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Ioannis Speggos: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Ioannis Daniil: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece.
Panagiotis Kouvatsos: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Chrysanthi Sidiropoulou: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Garifallia Linardaki: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Styliani Gerakari: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Georgios Chrysos: COVID-19 Department, Tzaneio General Hospital, 18536 Piraeus, Greece.
Katina Themeli-Digalaki: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece.
Olympia Zarkotou: Department of Microbiology, Tzaneio General Hospital, 18536 Piraeus, Greece. ORCID
Background: Bloodstream infections (BSI) caused by highly resistant pathogens in non-ICU COVID-19 departments pose important challenges. Methods: We performed a comparative analysis of incidence and microbial epidemiology of BSI in COVID-19 vs. non-COVID-19, non-ICU departments between 1 September 2020-31 October 2021. Risk factors for BSI and its impact on outcome were evaluated by a case-control study which included COVID-19 patients with/without BSI. Results: Forty out of 1985 COVID-19 patients developed BSI. The mean monthly incidence/100 admissions was 2.015 in COVID-19 and 1.742 in non-COVID-19 departments. Enterococcus and Candida isolates predominated in the COVID-19 group (p < 0.001 and p = 0.018, respectively). All Acinetobacter baumannii isolates were carbapenem-resistant (CR). In the COVID-19 group, 33.3% of Klebsiella pneumoniae was CR, 50% of Escherichia coli produced ESBL and 19% of Enterococcus spp. were VRE vs. 74.5%, 26.1% and 8.8% in the non-COVID-19 group, respectively. BSI was associated with prior hospitalization (p = 0.003), >2 comorbidities (p < 0.001), central venous catheter (p = 0.015), severe SARS-CoV-2 pneumonia and lack of COVID-19 vaccination (p < 0.001). In the multivariate regression model also including age and multiple comorbidities, only BSI was significantly associated with adverse in-hospital outcome [OR (CI95%): 21.47 (3.86−119.21), p < 0.001]. Conclusions: BSI complicates unvaccinated patients with severe SARS-CoV-2 pneumonia and increases mortality. BSI pathogens and resistance profiles differ among COVID-19/non-COVID-19 departments, suggesting various routes of pathogen acquisition.
