Table 1.
Demographic and clinical characteristics of COVID-19 patients with ICU-acquired Enterococcus spp. BSI.
| Variable | No. of patientsa | % | 95% CI |
|---|---|---|---|
| Demographic variables | |||
| Age in years, median (IQR) | 63 (58–69) | 59–66 | |
| Male gender | 33/43 | 77 | 62–88 |
| Medical history | |||
| Charlson score, median (IQR) | 3 (2–5) | 2–4 | |
| Diabetes mellitus | 9/43 | 21 | 11–36 |
| Chronic obstructive pulmonary disease | 3/43 | 7 | 2–18 |
| Chronic kidney disease | 8/43 | 19 | 9–33 |
| Previous myocardial infarction | 4/43 | 9 | 3–22 |
| Presence of solid neoplasm | 1/43 | 2 | 0–12 |
| Presence of hematological malignancy | 1/43 | 2 | 0–12 |
| Solid organ transplant | 0/43 | 0 | 0–7 |
| Haematopoietic stem cell transplantation | 0/43 | 0 | 0–7 |
| Admission from LTCF | 4/43 | 9 | 3–22 |
| Previous hospitalisation (within 6 months) | 7/43 | 16 | 7–30 |
| Previous VRE isolation (within 6 months) | 5/43 | 12 | 5–25 |
| Previous therapy with glycopeptides (within 6 months) | 5/43 | 12 | 5–25 |
| COVID-19 pneumonia | |||
| ARDS at hospital admissionb | 40/43 | 93 | 82–98 |
| Need for invasive mechanical ventilationc | 43/43 | 100 | 93–100 |
| Anti-inflammatory treatment for COVID-19 | |||
| Treatment with steroidsd | 34/43 | 79 | 64–89 |
| Treatment with tocilizumabe | 12/43 | 28 | 16–43 |
| Variables at BSI onsetf | |||
| Duration of ICU stay before BSI onset in days, median (IQR) | 18 (12–32) | 13–23 | |
| Recent treatment with cephalosporinsg | 34/43 | 79 | 64–89 |
| Neutropenia (ANC < 500 cell/mm3) | 0/43 | 0 | 0–7 |
| Presence of CVC | 42/43 | 98 | 88–100 |
| Pitt bacteraemia score | 6 (4–8) | 6–8 | |
| SOFA score | 8 (6–11) | 7–10 | |
| Septic shock | 21/43 | 49 | 33–64 |
| Infection variablesh | |||
| Aetiological agent | |||
| Enterococcus faecalis | 24/43 | 56 | 41–70 |
| Enterococcus faecium | 19/43 | 44 | 30–59 |
| Ampicillin-resistant E. faecalis | 0/24 | 0 | 0–13 |
| Vancomycin-resistant E. faecium | 7/19 | 37 | 17–61 |
| Polymicrobial BSIi | 19/43 | 44 | 30–59 |
| DENOVA score | 1 (0–2) | 1–1 | |
| CRBSI | 31/43 | 72 | 57–84 |
| Endocarditis | 0/43 | 0 | 0–7 |
| Source control | |||
| Performed/unnecessaryj | 40/43 | 93 | 82–98 |
| Not performed | 3/43 | 7 | 2–18 |
| Empirical therapyk | 41/43 | 95 | 84–99 |
| In vitro active empirical therapyl | 38/43 | 88 | 75–95 |
ANC, absolute neutrophil count; ARDS, acute respiratory distress syndrome; BSI, bloodstream infection; COVID-19, coronavirus disease 2019; CRBSI, catheter-related bloodstream infection; CI, confidence intervals; CVC, central venous catheter; DENOVA, long Duration of symptoms/Embolization/Number of positive cultures/Origin of infection unknown/Valve disease/Auscultation of murmur; ICU, intensive care unit; IQR, interquartile range; LTCF, log-term care facility; SOFA, sequential organ failure assessment; VRE, vancomycin-resistant enterococci.
aResults are presented as No. of patients/Total of patients unless otherwise indicated.
bAt least mild according to Berlin criteria [14].
cBefore the development of enterococcal BSI.
dMethylprednisolone 1 mg/kg/die (30/34, 88%), dexamethasone 8 mg/die (4/34, 12%).
eTocilizumab was administered at the dosage of 8 mg/kg (single intravenous infusion or repeated once).
fThe day when the first positive blood culture for Enterococcus spp. was drawn.
gDuring hospital stay before the development of BSI.
hRelated to the first episode of ICU-acquired enterococcal BSI in each patient.
iCoagulase-negative Staphylococcus spp. (n = 9), Bacillus cereus (n = 1), Candida auris (n = 1), Pseudomonas aeruginosa (n = 1), Morganella morganii (n = 1), Viridans Group Streptococcus spp. (n = 1), Candida albicans plus Candida auris (n = 1), Candida albicans plus Staphylococcus aureus (n = 1), coagulase-negative Staphylococcus spp. plus Bacteroides fragilis (n = 1), coagulase-negative Staphylococcus spp. plus Enterobacter aerogenes (n = 1), Enterobacter aerogenes plus Pseudomonas aeruginosa (n = 1).
jCVC removal (n = 28, performed in all cases within 96 h after collection of the first positive culture), not necessary (n = 12).
kVancomycin (n = 17), daptomycin (n = 10), linezolid (n = 3), tigecycline (n = 1), daptomycin plus linezolid (n = 6), daptomycin plus ampicillin (n = 1), daptomycin plus gentamicin (n = 1), vancomycin plus linezolid (n = 1), vancomycin plus amikacin plus linezolid (n = 1).
lWith at least one agent showing in vitro activity against the blood isolate: vancomycin (n = 14), daptomycin (n = 10), linezolid (n = 3), tigecycline (n = 1), daptomycin plus linezolid (n = 6), daptomycin plus ampicillin (n = 1), daptomycin plus gentamicin (n = 1), vancomycin plus linezolid (n = 1), vancomycin plus amikacin plus linezolid (n = 1).