Background. Multidrug-resistant Acinetobacter (MDR-Ab) is one of the most important pathogens causing superinfections in COVID-19 patients hospitalised in the intensive care unit (ICU). The occurrence of MDR-Ab superinfection significantly impairs the prognosis of patients in the ICU. Overuse of antibiotics in COVID-19 patients might contribute to the risk of developing MDR-Ab infection. Objective. The objective was to assess the role of prior antibiotic exposure as an independent predictor of MDR-Ab infection in COVID-19 patients admitted to the ICU. Methods. We conducted a retrospective cohort study in 90 patients admitted to the ICU of the Department of Infectology and Geographical Medicine, University Hospital in Bratislava, for respiratory failure due to COVID-19 between 1 September 2021 and 31 January 2022 (delta variant predominance). Patients underwent regular microbial screening. Superinfection was defined as infection occurring ≥48 h after admission. We assessed the role of prior antibiotic exposure and other factors as independent predictors of MDR-Ab isolation. Results. Fifty-eight male and 32 female patients were included in the analysis. Multidrug-resistant bacteria were cultured in 43 patients (47.8%), and MDR-Ab was isolated in 37 patients. Thirty-three (36.7%) patients had superinfection caused by MDR-Ab. Fifty-four (60%) patients were exposed to antibiotics prior to MDR-Ab isolation; of those, 35 (64.8%) patients received ceftriaxone. Prior exposure to ceftriaxone (odds ratio (OR) 4.1; 95% confidence interval (CI) 1.4–11.9; ), tocilizumab therapy (OR 4.7; 95% CI 1.3–15.0; ), and ICU length of stay exceeding 11 days (OR 3.7; 95% CI 1.3–10.3; ) were independent predictors of MDR-Ab infection. Conclusions. Prior exposure to ceftriaxone increases the risk of MDR-Ab infection in COVID-19 patients admitted to the ICU. Our findings suggest that antibiotic use in COVID-19 patients admitted to the ICU should be restricted to patients with documented bacterial superinfection.

中文翻译：

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抗菌治疗是重症监护病房 COVID-19 患者多重耐药不动杆菌感染的危险因素

背景。多重耐药不动杆菌(MDR-Ab) 是导致重症监护病房 (ICU) 住院的 COVID-19 患者重复感染的最重要病原体之一。MDR-Ab重复感染的发生显着损害ICU患者的预后。COVID-19 患者过度使用抗生素可能会增加发生 MDR-Ab 感染的风险。客观的。目的是评估既往抗生素暴露作为入住 ICU 的 COVID-19 患者 MDR-Ab 感染的独立预测因素的作用。方法。我们对 2021 年 9 月 1 日至 2022 年 1 月 31 日期间入住布拉迪斯拉发大学医院感染学和地理医学科 ICU 的 90 名因 COVID-19 导致呼吸衰竭的患者（以 δ 变异为主）进行了一项回顾性队列研究。患者定期接受微生物筛查。二重感染定义为入院后≥48小时发生感染。我们评估了既往抗生素暴露和其他因素作为 MDR-Ab 分离的独立预测因素的作用。结果。分析中包括 58 名男性患者和 32 名女性患者。43例患者（47.8%）培养出多重耐药菌，37例患者分离出MDR-Ab。33 例（36.7%）患者存在由 MDR-Ab 引起的重复感染。54 名 (60%) 患者在 MDR-Ab 分离之前接触过抗生素；其中，35 名 (64.8%) 患者接受了头孢曲松治疗。既往接触过头孢曲松（比值比 (OR) 4.1；95% 置信区间 (CI) 1.4–11.9；），托珠单抗治疗（OR 4.7；95% CI 1.3–15.0；），并且 ICU 住院时间超过 11 天（OR 3.7；95% CI 1.3–10.3；）是 MDR-Ab 感染的独立预测因子。结论。先前接触头孢曲松会增加入住 ICU 的 COVID-19 患者感染 MDR-Ab 的风险。我们的研究结果表明，入住 ICU 的 COVID-19 患者中抗生素的使用应仅限于有细菌重复感染记录的患者。