Bacterial infections in critically ill patients with SARS-2-COVID-19 infection: results of a prospective observational multicenter study

Abstract

Purpose To investigate the prevalence, incidence and characteristics of bacterial infections and their impact on outcome in critically ill patients infected with COVID-19. Methods We conducted a prospective observational study in eight Italian ICUs from February to May 2020; data were collected through an interactive electronic database. Kaplan-Meier analysis (limit product method) was used to identify the occurrence of infections and risk of acquisition. Results During the study period 248 patients were recruited in the eight participating ICUs. Ninety (36.3%) patients developed at least one episode of secondary infection. An ICU length of stay between 7 and 14 days was characterized by a higher occurrence of infectious complications, with ventilator-associated pneumonia being the most frequent. At least one course of antibiotic therapy was given to 161 (64.9%) patients. Overall ICU and hospital mortality were 33.9% and 42.9%, respectively. Patients developing bacteremia had a higher risk of ICU mortality [45.9% vs. 31.6%, odds ratio 1.8 (95% CI 0.9-3.7), p = 0.069] and hospital mortality [56.8% vs. 40.3%, odds ratio 1.9 (95% CI 1.1-3.9), p = 0.04]. ConclusionIn critically ill patients infected with COVID-19 the incidence of bacterial infections is high and associated with worse outcomes. Regular microbiological surveillance and strict infection control measures are mandated.

Characterization of antimicrobial use and co-infections among hospitalized patients with COVID-19: a prospective observational cohort study

“…In addition, we used a longitudinal approach and did not focus on early infections only [ 3 , 19 ]. Nosocomial infection rate on ICU was 28% in our cohort and is in line with what has been reported before [ 20 ]. Respiratory co-infections occurred in 29.4% of all patients, most of them on IMV with an overall rate of 52.7%.…”

Elevated Levels of Neutrophil Activated Proteins, Alpha-Defensins (DEFA1), Calprotectin (S100A8/A9) and Myeloperoxidase (MPO) Are Associated With Disease Severity in COVID-19 Patients

“…However, there was a distinct possibility of the role of secondary infections in modulating the expression of three neutrophil secretory proteins in severe COVID-19 patients. Importantly, similar to the reports of higher proportion of secondary infection in patients from China ( Zhou et al., 2020 ), Italy ( De Santis et al., 2021 ), France ( Roger et al., 2021 ) and UK ( Hughes et al., 2020 ), 61% of severe patients from our study suffered from secondary infection. The observations of raised levels of these proteins much before the appearance of secondary infection ( Figures 3B–D ) provide important evidence for the association of higher expression levels of DEFA1/Calprotectin/MPO levels with COVID-19 severity.…”

High Rates of Bacterial Pulmonary Co-Infections and Superinfections Identified by Multiplex PCR among Critically Ill COVID-19 Patients

“…As was previously reported [10,24], P. aeruginosa and S. aureus including MRSA, MSSA and Enterobacterales were the most common microorganisms seen in this study. A recent Italian study prospectively followed 248 patients in eight ICUs, and found 36% secondary bacterial infection, primarily VAP, with the same dominant bacteria as were reported in our study but without the use of molecular diagnostic methods [25].…”