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Introduction <p>Coronavirus disease 2019 has been associated with increased antimicrobial use and a rising burden of healthcare-associated infections, potentially contributing to antimicrobial resistance. This study aimed to characterize the epidemiology, microbiological profile, and clinical outcomes of healthcare-associated infections, and to identify factors independently associated with mortality in critically ill patients.</p> Methods <p>This retrospective cohort study included adult patients admitted to an intensive care unit with confirmed COVID-19 between 2020 and 2022. Demographic, clinical, microbiological, and outcome data were analyzed. Multivariate logistic regression was used to identify factors independently associated with mortality.</p> Results <p>Among 408 patients, 130 healthcare-associated infections occurred in 118 individuals (28.9%). Ventilator-associated pneumonia (47.7%) and bloodstream infections (42.3%) predominated. Gram-negative bacteria accounted for 79.2% of isolates, mainly <i>Acinetobacter baumannii</i> (24.6%) and <i>Klebsiella pneumoniae</i> (16.2%), with high rates of carbapenem resistance. Notably, 21.4% (22/103) of Gram-negative isolates were intrinsically resistant to polymyxin B, including <i>Serratia</i> spp., <i>Providencia stuartii</i>, <i>Burkholderia cepacia</i>, and <i>Stenotrophomonas maltophilia</i>. <i>Ralstonia mannitolilytica</i> (3.1%) was also identified and has been associated with reduced susceptibility to polymyxins. Patients with healthcare-associated infections had longer intensive care unit stays and higher crude mortality. Overall mortality was 54.4%. In multivariate analysis, carbapenem resistance (adjusted odds ratio 2.91; 95% confidence interval 1.35–6.28; <i>p</i> = 0.007) was independently associated with mortality.</p> Conclusions <p>Healthcare-associated infections were frequent and predominantly caused by multidrug-resistant Gram-negative organisms. The high proportion of pathogens intrinsically resistant to polymyxin B and the association between carbapenem resistance and mortality underscore the need for strengthened infection control and antimicrobial stewardship.</p>

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Multidrug resistant infections in COVID-19 patients drive the transition toward a post antibiotic era

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Alex Mauricio Garcia Santos,
  • Eliane Campos Coimbra,
  • Jakson Gomes Figueiredo,
  • João Vitor Alves de Menezes Feitosa,
  • Diego Lins Guedes

摘要

Introduction

Coronavirus disease 2019 has been associated with increased antimicrobial use and a rising burden of healthcare-associated infections, potentially contributing to antimicrobial resistance. This study aimed to characterize the epidemiology, microbiological profile, and clinical outcomes of healthcare-associated infections, and to identify factors independently associated with mortality in critically ill patients.

Methods

This retrospective cohort study included adult patients admitted to an intensive care unit with confirmed COVID-19 between 2020 and 2022. Demographic, clinical, microbiological, and outcome data were analyzed. Multivariate logistic regression was used to identify factors independently associated with mortality.

Results

Among 408 patients, 130 healthcare-associated infections occurred in 118 individuals (28.9%). Ventilator-associated pneumonia (47.7%) and bloodstream infections (42.3%) predominated. Gram-negative bacteria accounted for 79.2% of isolates, mainly Acinetobacter baumannii (24.6%) and Klebsiella pneumoniae (16.2%), with high rates of carbapenem resistance. Notably, 21.4% (22/103) of Gram-negative isolates were intrinsically resistant to polymyxin B, including Serratia spp., Providencia stuartii, Burkholderia cepacia, and Stenotrophomonas maltophilia. Ralstonia mannitolilytica (3.1%) was also identified and has been associated with reduced susceptibility to polymyxins. Patients with healthcare-associated infections had longer intensive care unit stays and higher crude mortality. Overall mortality was 54.4%. In multivariate analysis, carbapenem resistance (adjusted odds ratio 2.91; 95% confidence interval 1.35–6.28; p = 0.007) was independently associated with mortality.

Conclusions

Healthcare-associated infections were frequent and predominantly caused by multidrug-resistant Gram-negative organisms. The high proportion of pathogens intrinsically resistant to polymyxin B and the association between carbapenem resistance and mortality underscore the need for strengthened infection control and antimicrobial stewardship.