Bacterial and fungal infections in COVID-19 patients: A matter of concern

Zhou, Pengcheng; Liu, Zhenguo; Chen, Yuhua; Xiao, Yinzong; Huang, Xun; Xue, Fan

doi:10.1017/ice.2020.156

Cited by 149 publications

(131 citation statements)

References 6 publications

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“…Our study does suggest that following admission and intubation, COVID-19 pneumonia patients have the same predisposition to colonization and infections due to nosocomial pathogens wellknown in hospital-acquired and ventilator-associated pneumonias. The literature on bacterial sputum cultures in COVID-19 report high rates of antibiotic use [28,29]. We observed this as well and demonstrated antimicrobial resistance development in over 10% of bacterial isolates late in patients' hospitalisations; this had been predicted [30] but also has been a topic of considerable debate [31,32,33,34].…”

Section: Discussionsupporting

confidence: 66%

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Liu

Yaron

Piraino

et al. 2020

Preprint

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Background: Coronavirus SARS-CoV-2 causes COVID-19 illness which can progress to severe pneumonia. Empiric antibacterials are often employed though frequency of bacterial superinfection is debated and concerns raised about selection of bacterial antimicrobial resistance. We evaluated sputum bacterial and fungal growth from 165 intubated COVID-19 pneumonia patients. Objectives were to determine frequency of culture positivity, risk factors for and outcomes of positive cultures, and timing of antimicrobial resistance development. Methods: Retrospective reviews were conducted of COVID-19 pneumonia patients requiring intubation admitted to a 1,058-bed four community hospital system on the east coast United States, March 1 to May 1, 2020. Length of stay (LOS) was expressed as mean (standard deviation); 95% confidence interval (95% CI) was computed for overall mortality rate using the exact binomial method, and overall mortality was compared across each level of a potential risk factor using a Chi-Square Test of Independence. All tests were two-sided, and significance level was set to 0.05.Results: Average patient age was 68.7 years. Eighty-three patients (50.3% of total) originated from home, 10 from group homes (6.1% of total), and 72 from nursing facilities (43.6% of total). Mortality was 62.4%, highest for nursing home residents (80.6%). Findings from 253 sputum cultures overall were evaluated and did not suggest acute bacterial or fungal infection in 89 (54%) of 165 individuals sampled within 24 hours of intubation. Cultures > one week following intubation did grow potential pathogens in 72 (64.9%) of 111 cases with 70.8% consistent with late pneumonia and 29.2% suggesting colonization. Twelve (10.8% of total) of these late post-intubation cultures revealed worsened antimicrobial resistance predominantly in Pseudomonas, Enterobacter, or Staphylococcus aureus.Conclusions: In severe COVID-19 pneumonia, a radiographic ground glass interstitial pattern and lack of purulent sputum suggest antibacterials are not needed. Discontinuation of empiric antibacterials should be considered after 48 hours in absence of sputum to culture or results reported "without growth" or "normal flora." Continuing longterm hospitalisation and antibiotics are associated with sputum cultures reflective of hospital-acquired microbes and increasing antimicrobial resistance.Trial registration: Not applicable as this was a retrospective chart review study without interventional arm.

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Section: Discussionsupporting

confidence: 66%

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Liu

Yaron

Piraino

et al. 2020

Preprint

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“…This entailed a high number of relocated healthcare personnel which often had to be employed in "non conventional" temporary ICUs, such as the operating theatres. Moreover, infection control measures were strongly directed at avoiding the spread of airborne viral pathogens, and, during the peak of the pandemic, less attention could have been paid to ordinary infection control practices, and care bundles when handling IV lines or tracheal tubes [4]. The vast majority of our cohort received empiric antibiotic treatment with ceftriaxone at hospital admission, as was advocated by the early literature and guidelines [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Bacterial and fungal superinfection during Intensive Care Unit (ICU) stay has been reported in other outbreaks of severe acute respiratory syndrome (SARS), but there is limited data available regarding COVID-19 patients. Many authors recognize the importance of superinfection but de nitive data is still lacking [4,5]. Reported incidence varies between 3,6% to 43% [6], and no study thus far, has focused speci cally on the subpopulation of ICU patients.…”

Section: Introductionmentioning

confidence: 99%

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Bardi

Pintado

Gómez-Rojo

et al. 2020

Preprint

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Background: Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients.Aim: To assess the characteristics and outcome of ICU-acquired infections in COVID-19 patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%) and urinary tract infection (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.

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“…Several issues related to the COVID-19 epidemic are starting to cause concern including the occurrence of bacterial and fungal infections, the plausible crisis of antimicrobial stewardship programs and an increase in antimicrobial resistance [1] , [2] , [3] . The real extent of these issues is poorly known due to the lack of ad hoc studies.…”

mentioning

confidence: 99%

Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming “collateral effect”

Cataldo

Tetaj

Selleri

et al. 2020

Journal of Global Antimicrobial Resistance

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Highlights COVID-19 patients have an exaggerated risk of acquiring BSI during ICU stay The incidence of ICU-acquired BSI in COVID-19 patients is higher than that reported in European ICUs in the pre-COVID-19 period The commonest etiologic agents of BSI were intestinal commensals. A high rate of acquisition of VRE colonisation was observed.

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Bacterial and fungal infections in COVID-19 patients: A matter of concern

Cited by 149 publications

References 6 publications

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Bacterial and Fungal Growth in Sputum Cultures from 165 COVID-19 Pneumonia Patients Requiring Intubation: Evidence for Antimicrobial Resistance Development and Analysis of Risk Factors

Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming “collateral effect”

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