Incidence and Predictors of Healthcare-Associated Infections in Patients Admitted to a Temporary Intensive Care Unit during the COVID-19 Pandemic Waves: A Two-Year (2021–2023) Retrospective Cohort Study in Rome, Italy
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients and Data Collection
2.2. Statistical Analysis
3. Results
3.1. Characteristics of Patients
3.2. Occurrence and Characteristics of HAIs and Isolated Microorganisms
3.3. Multivariable Analysis of Occurrence of First HAI
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Period of SARS-CoV-2 Variant Dominance | |||||||
---|---|---|---|---|---|---|---|
Alpha | Delta | Omicron BA.1 | Omicron BA.2 | Omicron BA.5 | Omicron XBB | p-Value | |
1 Mar 2021– 18 Jun 2021 | 19 Jun 2021–31 Dec 2021 | 1 Jan 2022– 12 Mar 2022 | 13 Mar 2022– 6 Jun 2022 | 7 Jun 2022– 12 Feb 2023 | 13 Feb 2023–15 Jul 2023 | ||
Patients, N | 66 | 53 | 45 | 46 | 107 | 38 | |
Cumulative patient-days from admission | 978 | 789 | 825 | 658 | 1765 | 726 | |
Age, mean (SD) | 60.3 (12.9) | 64.4 (11.0) | 64.8 (11.5) | 68.7 (16.3) | 69.5 (13.3) | 72.5 (14.6) | <0.001 |
Age, median (IQR) | 61.1 (49.5–70.8) | 64.5 (55.2–72.3) | 66.0 (59.1–73.6) | 72.7 (60.7–82.5) | 72.1 (61.6–78.9) | 75.1 (64.4–84.1) | |
Gender, N (%) | |||||||
Female | 25 (37.9) | 18 (34.0) | 11 (24.4) | 15 (32.6) | 31 (29.0) | 18 (47.4) | 0.258 |
Male | 41 (62.1) | 35 (66.0) | 34 (75.6) | 31 (67.4) | 76 (71.0) | 20 (52.6) | |
Type of admission to ICU, N (%) | <0.001 | ||||||
Other hospital | 2 (3.0) | 6 (11.3) | 7 (15.6) | 9 (19.6) | 35 (32.7) | 12 (31.6) | |
Other ward | 19 (28.8) | 17 (32.1) | 2 (4.4) | 10 (21.7) | 26 (24.3) | 5 (13.2) | |
Emergency department | 39 (59.1) | 29 (54.7) | 32 (71.1) | 21 (45.7) | 38 (35.5) | 20 (52.6) | |
Other | 6 (9.1) | 1 (1.9) | 4 (8.9) | 6 (13.0) | 8 (7.5) | 1 (2.6) | |
Coexisting conditions, N (%) | <0.001 | ||||||
No condition | 36 (54.5) | 24 (45.3) | 18 (40.0) | 6 (13.0) | 24 (22.4) | 7 (18.4) | |
One condition | 17 (25.8) | 13 (24.5) | 11 (24.4) | 18 (39.1) | 36 (33.6) | 11 (28.9) | |
Two conditions or more | 13 (19.7) | 16 (30.2) | 16 (35.6) | 22 (47.8) | 47 (43.9) | 20 (52.6) | |
Coexisting conditions, N (%) | |||||||
Hypertension | 20 (30.3) | 24 (45.3) | 20 (44.4) | 26 (56.5) | 55 (51.4) | 22 (57.9) | 0.036 |
Diabetes mellitus | 9 (13.6) | 7 (13.2) | 9 (20.0) | 10 (21.7) | 27 (25.2) | 11 (28.9) | 0.235 |
Obesity | 5 (7.6) | 8 (15.1) | 5 (11.1) | 5 (10.9) | 4 (3.7) | 2 (5.3) | 0.18 |
COPD | 2 (3.0) | 1 (1.9) | 5 (11.1) | 11 (23.9) | 12 (11.2) | 6 (15.8) | 0.003 |
Asthma | 1 (1.5) | 2 (3.8) | 2 (4.4) | 0 (0.0) | 1 (0.9) | 0 (0.0) | 0.385 |
Bronchiectasis | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (2.2) | 0 (0.0) | 0 (0.0) | 0.241 |
Pulmonary fibrosis | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (0.9) | 0 (0.0) | 0.803 |
Chronic heart disease | 3 (4.5) | 2 (3.8) | 3 (6.7) | 2 (4.3) | 5 (4.7) | 10 (26.3) | <0.001 |
Chronic kidney disease | 1 (1.5) | 3 (5.7) | 5 (11.1) | 10 (21.7) | 22 (20.6) | 2 (5.3) | <0.001 |
Chronic liver disease | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (2.2) | 0 (0.0) | 0 (0.0) | 0.241 |
Active neoplasm | 5 (7.6) | 4 (7.5) | 4 (8.9) | 12 (26.1) | 28 (26.2) | 4 (10.5) | 0.001 |
Neutropenia | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (2.2) | 0 (0.0) | 0 (0.0) | 0.241 |
Organ transplantation | 0 (0.0) | 1 (1.9) | 0 (0.0) | 0 (0.0) | 1 (0.9) | 0 (0.0) | 0.696 |
SAPS II, mean (SD) (N = 229) | 28.7 (11.2) | 38.7 (9.4) | 59.0 (-) | 40.8 (17.3) | 41.7 (16.3) | 37.2 (15.7) | NA |
Intubated at admission, N (%) | <0.001 | ||||||
Non-intubated | 55 (83.3) | 30 (56.6) | 26 (57.8) | 29 (63.0) | 55 (51.4) | 24 (63.2) | |
Intubated, other reasons | 2 (3.0) | 2 (3.8) | 6 (13.3) | 12 (26.1) | 32 (29.9) | 6 (15.8) | |
Intubated with COVID-19 pneumonia | 9 (13.6) | 21 (39.6) | 13 (28.9) | 5 (10.9) | 20 (18.7) | 8 (21.1) | |
Use of devices before first HAI, N (%) | |||||||
Central venous catheter | 49 (74.2) | 42 (79.2) | 35 (77.8) | 30 (65.2) | 87 (81.3) | 29 (76.3) | 0.404 |
Mechanical ventilation | 33 (50.0) | 41 (77.4) | 33 (73.3) | 29 (63.0) | 71 (66.4) | 20 (52.6) | 0.017 |
Urinary catheter | 65 (98.5) | 53 (100.0) | 43 (95.6) | 46 (100.0) | 106 (99.1) | 38 (100.0) | 0.294 |
Antibiotic consumption in days, mean, SD | |||||||
Antifungal agents (N = 176) | 14.5 (11.5) | 12.7 (8.9) | 15.2 (14.8) | 12.7 (10.7) | 15.8 (13.0) | 15.3 (17.7) | 0.816 |
Carbapenems (N = 172) | 12.5 (9.2) | 11.1 (7.3) | 11.1 (6.8) | 10.8 (8.2) | 10.6 (6.9) | 10.9 (8.9) | 0.976 |
Extended-spectrum cephalosporins (N = 156) | 8.4 (9.7) | 7.8 (6.6) | 13.2 (11.8) | 7.3 (5.2) | 11.6 (10.0) | 9.2 (7.8) | 0.454 |
Glycopeptides (N = 186) | 10.9 (7.8) | 10.1 (6.6) | 13.4 (9.5) | 10.2 (6.4) | 13.2 (10.0) | 16.1 (14.6) | 0.618 |
Macrolides (N = 115) | 6.0 (4.3) | 8.1 (4.9) | 8.5 (5.6) | 8.1 (2.7) | 5.8 (3.0) | 9.4 (4.5) | 0.006 |
Penicillins (N = 210) | 7.6 (4.3) | 8.6 (4.6) | 11.3 (8.8) | 8.5 (7.8) | 9.3 (6.7) | 12.5 (8.6) | 0.361 |
Polymyxins (N = 93) | 11.8 (6.7) | 8.9 (3.9) | 14.3 (12.4) | 9.4 (9.7) | 9.6 (5.1) | 11.5 (4.9) | 0.638 |
Length of ICU stay in days, mean (SD) | 14.8 (12.2) | 14.9 (8.5) | 18.3 (15.8) | 14.3 (10.7) | 16.5 (12.7) | 19.1 (18.2) | 0.604 |
ICU deaths, N (%) | 20 (30.3) | 35 (66.0) | 32 (71.1) | 22 (47.8) | 54 (50.5) | 13 (34.2) | <0.001 |
Mortality rate per 1000 patient-days (95% CI) | 20.4 (11.5–29.4) | 44.4 (29.7–59.1) | 38.8 (25.3–52.2) | 33.4 (19.5–47.4) | 30.6 (22.4–38.8) | 17.9 (8.2–27.6) | NA |
Period of SARS-CoV-2 Variant Dominance | |||||||
---|---|---|---|---|---|---|---|
Alpha | Delta | Omicron BA.1 | Omicron BA.2 | Omicron BA.5 | Omicron XBB | p-Value | |
1 Mar 2021–18 Jun 2021 | 19 Jun 2021–31 Dec 2021 | 1 Jan 2022– 12 Mar 2022 | 13 Mar 2022–6 Jun 2022 | 7 Jun 2022– 12 Feb 2023 | 13 Feb 2023– 15 Jul 2023 | ||
Type of HAI (N = 138), N (%) | <0.001 | ||||||
CR-BSI | 0 (0.0) | 5 (16.7) | 1 (4.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
VAP | 11 (32.4) | 15 (50.0) | 13 (61.9) | 4 (36.4) | 16 (57.1) | 8 (57.1) | |
CAUTI | 18 (52.9) | 4 (13.3) | 3 (14.3) | 3 (27.3) | 3 (10.7) | 2 (14.3) | |
BUO | 5 (14.7) | 6 (20.0) | 4 (19.0) | 4 (36.4) | 9 (32.1) | 4 (28.6) | |
Patients with HAIs (N = 355), N (%) | 0.023 | ||||||
No HAI | 45 (68.2) | 31 (58.5) | 28 (62.2) | 37 (80.4) | 88 (82.2) | 29 (76.3) | |
One HAI | 11 (16.7) | 14 (26.4) | 14 (31.1) | 7 (15.2) | 11 (10.3) | 6 (15.8) | |
Two HAIs or more | 10 (15.2) | 8 (15.1) | 3 (6.7) | 2 (4.3) | 8 (7.5) | 3 (7.9) |
SHR | 95% CI | p-Value | |
---|---|---|---|
Period of SARS-CoV-2 variant dominance (Ref. Alpha: 1 Mar 2021–18 Jun 2021) | |||
Delta: 19 Jun 2021–31 Dec 2021 | 0.65 | 0.31–1.34 | 0.241 |
Omicron BA.1: 1 Jan 2022–12 Mar 2022 | 0.40 | 0.16–0.96 | 0.040 |
Omicron BA.2: 13 Mar 2022–6 Jun 2022 | 0.30 | 0.13–0.72 | 0.007 |
Omicron BA.5: 7 Jun 2022–12 Feb 2023 | 0.23 | 0.11–0.50 | <0.001 |
Omicron XBB: 13 Feb 2023–15 Jul 2023 | 0.34 | 0.14–0.82 | 0.016 |
Age | 0.99 | 0.98–1.01 | 0.463 |
Male gender (Ref. Female) | 4.01 | 1.68–9.57 | 0.002 |
SAPS II | 1.01 | 0.99–1.02 | 0.538 |
Coexisting conditions (Ref. None) | |||
One coexisting condition | 1.24 | 0.74–2.08 | 0.414 |
Two coexisting conditions or more | 0.98 | 0.57–1.70 | 0.949 |
Intubated at admission (Ref. Non-intubated) | |||
Intubated, other reasons | 1.54 | 0.79–3.01 | 0.207 |
Intubated with COVID-19 pneumonia | 1.82 | 1.08–3.07 | 0.025 |
Use of carbapenems, in days | 0.87 | 0.82–0.93 | <0.001 |
Use of glycopeptides, in days | 0.98 | 0.96–1.01 | 0.159 |
Use of penicillins, in days | 0.99 | 0.96–1.02 | 0.498 |
Time-varying coefficients | |||
Male gender * Time | 0.92 | 0.88–0.97 | 0.002 |
Use of glycopeptides, in days * Time | 1.00 | 1.00–1.01 | 0.001 |
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Sciurti, A.; Baccolini, V.; Ceparano, M.; Isonne, C.; Migliara, G.; Iera, J.; Alessandri, F.; Ceccarelli, G.; Marzuillo, C.; Tellan, G.; et al. Incidence and Predictors of Healthcare-Associated Infections in Patients Admitted to a Temporary Intensive Care Unit during the COVID-19 Pandemic Waves: A Two-Year (2021–2023) Retrospective Cohort Study in Rome, Italy. Antibiotics 2024, 13, 842. https://doi.org/10.3390/antibiotics13090842
Sciurti A, Baccolini V, Ceparano M, Isonne C, Migliara G, Iera J, Alessandri F, Ceccarelli G, Marzuillo C, Tellan G, et al. Incidence and Predictors of Healthcare-Associated Infections in Patients Admitted to a Temporary Intensive Care Unit during the COVID-19 Pandemic Waves: A Two-Year (2021–2023) Retrospective Cohort Study in Rome, Italy. Antibiotics. 2024; 13(9):842. https://doi.org/10.3390/antibiotics13090842
Chicago/Turabian StyleSciurti, Antonio, Valentina Baccolini, Mariateresa Ceparano, Claudia Isonne, Giuseppe Migliara, Jessica Iera, Francesco Alessandri, Giancarlo Ceccarelli, Carolina Marzuillo, Guglielmo Tellan, and et al. 2024. "Incidence and Predictors of Healthcare-Associated Infections in Patients Admitted to a Temporary Intensive Care Unit during the COVID-19 Pandemic Waves: A Two-Year (2021–2023) Retrospective Cohort Study in Rome, Italy" Antibiotics 13, no. 9: 842. https://doi.org/10.3390/antibiotics13090842