{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:51:38Z","timestamp":1792461098583,"version":"4.5.0"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Bacterial superinfections are common complications during viral infections, but the impact of multidrug-resistant (MDR) pathogens in critically ill patients affected by coronavirus disease 2019 (COVID-19) is still debated. Methods: This is an observational, monocentric, and prospective study designed to investigate the incidence, risk factors, and outcomes of MDR bacterial superinfections in COVID-19 patients admitted to the intensive care unit (ICU). Results: A high incidence of superinfections (66%, 159\/241) was observed: ventilator-associated pneumonia (VAP) (65%, 104\/159) and bloodstream infection (BSI, 32%, 51\/159) were the most common. Superinfections, Extra-Corporeal Membrane Oxygenation (ECMO) support, and prone positioning increased the risk of death five, four, and more-than-two times, respectively (OR = 5.431, IC 95%: 1.637\u201318.014; 4.462, IC 95%: 1.616\u201312.324 and 2.346, IC 95%: 1.127\u20134.883). MDR bacteria were identified in 61% of patients with superinfection, with a cumulative incidence of 37.2% at day 14. Carbapenem-resistant Acinetobacter baumannii (CR-AB) and CR-Klebsiella pneumoniae (CR-KP) were the most common causative agents (24.3% and 13.7%). CR-AB was found to significantly increase both ICU and in-hospital mortality (76.4% and 78.2%), whereas CR-KP had no direct impact on mortality. Prior rectal colonization (p &lt; 0.0001), mechanical ventilation (p = 0.0017), a prolonged ICU stay (p &lt; 0.0001), the use of iNO (p = 0.0082), vasopressors (p = 0.0025), curarization (p = 0.0004), and prone positioning (p = 0.0084) were found to be risk factors for CR-AB. Conclusions: Critically ill COVID-19 patients are at high risk of developing MDR superinfection. While CR-KP had no direct impact on mortality, CR-AB appeared to increase ICU and in-hospital mortality.<\/jats:p>","DOI":"10.3390\/jcm14020410","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T06:25:54Z","timestamp":1736490354000},"page":"410","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of Multidrug-Resistant Bacteria in a Cohort of COVID-19 Critically Ill Patients: Data from a Prospective Observational Study Conducted in a High-Antimicrobial-Resistance-Prevalence Center"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9341-965X","authenticated-orcid":false,"given":"Giorgia","family":"Montrucchio","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"},{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Grillo","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7837-4457","authenticated-orcid":false,"given":"Eleonora","family":"Balzani","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Gavanna","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0891-2525","authenticated-orcid":false,"given":"Gabriele","family":"Sales","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"},{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Bonetto","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marinella","family":"Zanierato","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1647-2411","authenticated-orcid":false,"given":"Vito","family":"Fanelli","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"},{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0194-142X","authenticated-orcid":false,"given":"Claudia","family":"Filippini","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Corcione","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"},{"name":"Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8338-0130","authenticated-orcid":false,"given":"Francesco Giuseppe","family":"De Rosa","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Turin, 10124 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8101-4196","authenticated-orcid":false,"given":"Antonio","family":"Curtoni","sequence":"additional","affiliation":[{"name":"Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy"},{"name":"Microbiology and Virology Laboratory, Citt\u00e0 Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6549-4553","authenticated-orcid":false,"given":"Cristina","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy"},{"name":"Microbiology and Virology Laboratory, Citt\u00e0 Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7059-0622","authenticated-orcid":false,"given":"Luca","family":"Brazzi","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, University of Turin, 10126 Turin, Italy"},{"name":"Department of Anesthesia, Intensive Care and Emergency, Citt\u00e0 della Salute e della Scienza Hospital, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Musuuza, J.S., Watson, L., Parmasad, V., Putman-Buehler, N., Christensen, L., and Safdar, N. 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