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

Rosario Cultrera, Brunella Quarta, Carlo Alberto Volta, Diana Campioni, Daniela Segala, Roberto Pora, Savino Spadaro

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.