Multidrug Resistant Bacterial Co-Infections in Critically Ill Patients with COVID-19: A Review after Three Years of Pandemic

Secondary bacterial infections and co-infections frequently affect COVID-19 patients. However, bacterial coinfection rates increase in patients admitted in the Intensive Care Units (ICUs), and those diseases can be due to superinfections by Multidrug-Resistant (MDR) bacteria. Most of these infections are related to high-risk carbapenemase-producing clones and occasionally with resistance to new β-lactam-β-lactamase inhibitor combinations. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and the need to maintain antimicrobial stewardship and infection control programs in pandemic crises. Additionally, the SARS-CoV-2 pandemic highlighted the challenge that an emerging pathogen provides in adapting prevention measures regarding both the risk of exposure to caregivers and the need to maintain quality of care

Irrelevance of Panton-Valentine leukocidin in hidradenitissuppurativa: results from a pilot, observational study

Panton-Valentine leukocidin (PVL) appears to be a virulence factor which, among others, can exacerbate the pathogenicity ofStaphylococcus aureusinfections, especially inducing severe necrotic, deep-seated skin infections, abscesses, and recurrences.These peculiarities have some overlaps with hidradenitis suppurativa (HS). Our main aim was to assess ifS. aureusproducingPVL could have some role in influencing clinical features and/or course of HS, specifically in the suppuration and recurrence oflesions. This pilot, mono-centric, observational study included all adult subjects affected with HS consecutively referring to ourHS clinic over a 3-month period. Clinically evident suppuration and at least 2 weeks wash out from any antibiotic were the maininclusion criteria. Purulent material from HS skin lesions was collected with swabs in order to isolate micro-organisms, withspecific regard toS. aureus.Detection of PVL was performed by real-time quantitative PCR (RT-qPCR). We also analyzedpurulent material from suppurative skin lesions other than HS, as a control. Thirty HS patients were included; 29 purulent lesions(96.7%) harbored at least one bacterial species. Five (16.7%) swab samples were positive forS. aureus, none of which waspositive for PVL genes. Among the 30 purulent disorders included as controls, 8 (26.3%) were positive forS. aureus;ofthese,4strains (50%) expressed LPV. The study results seem to exclude the pathogenetic involvement ofS. aureusproducing PVL inHS; as a result, PVL does not seem to represent a potential target in the future development of HS treatment

Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings

Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenemresistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group