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

• Published in: Frontiers in cellular and infection microbiology Vol. 14; p. 1297312
• Main Authors: Janc, Jarosław, Słabisz, Natalia, Woźniak, Anna, Łysenko, Lidia, Chabowski, Mariusz, Leśnik, Patrycja
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 16.04.2024
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; beta-Lactamases - genetics; beta-Lactamases - metabolism; Cellular and Infection Microbiology; coronavirus disease 2019; COVID-19 - microbiology; COVID-19 - mortality; Drug Resistance, Multiple, Bacterial; Female; hospital-acquired infection; Humans; Intensive Care Units; Klebsiella Infections - drug therapy; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Male; metallo-B-lactamase; Middle Aged; mortality; SARS-CoV-2; mortality; metallo-B-lactamase; hospital-acquired infection; coronavirus disease 2019; Klebsiella pneumoniae
• ISSN: 2235-2988; 2235-2988
• DOI: 10.3389/fcimb.2024.1297312

During the coronavirus disease 2019 (COVID-19) pandemic, in patients treated for SARS-CoV-2 infection, infections with the 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 NDM infection and other bacterial infections on mortality in patients treated in ICUs due to COVID-19. 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 NDM (N = 30), and patients with COVID-19 infection and infection of bacterial etiology other than 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. Bacterial infection, including with 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. 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.