Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and inhospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU-acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 -3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.

Introduction: There is little data in the literature on acute kidney injury (AKI) in Covid-19 cases, although relevant in clinical practice in the ICU, especially in Brazil. Our goal was to identify the incidence of AKI, predictive factors and impact on hospital mortality. Method: Retrospective cohort of patients with Covid-19 admitted to the ICU. AKI was defined according to KDIGO criteria. Data was collected from electronic medical records between March 17 and April 26. Results: Of the 102 patients, 55.9% progressed with AKI, and the majority (66.7%) was classified as stage 3. Multivariate logistic regression showed age (RC 1.101; 95% CI 1.026 - 1.181; p = 0.0070), estimated glomerular filtration rate - eGFR (RC 1.127; 95% CI 1.022 - 1.243; p = 0.0170) and hypertension (RC 3.212; 95% CI 1.065 - 9.690; p = 0.0380) as independent predictors of AKI. Twenty-three patients died. In the group without kidney injury, there were 8.9% deaths, while in the group with AKI, 33.3% of patients died (RR 5.125; 95% CI 1.598 - 16.431; p = 0.0060). The average survival, in days, was higher in the group without AKI. Cox multivariate analysis showed age (RR 1.054; 95% CI 1.014 - 1.095; p = 0.0080) and severe acute respiratory distress syndrome (RR 8.953; 95% CI 1.128 - 71.048; p = 0.0380) as predictors of hospital mortality. Conclusion: We found a high incidence of AKI; and as predictive factors for its occurrence: age, eGFR and hypertension. AKI was associated with higher hospital mortality.

The great clinico-functional divergence in elderly asthmatics shows the need to establish functional measurements as markers of asthma severity.

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