Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients

Abstract

Objectives While superinfections are associated with unfavourable disease course, their impact on clinical outcomes in critically ill COVID-19 patients remains largely unknown. We aimed to investigate the burden of superinfections in COVID-19 patients. Methods In this prospective single centre cohort study in an intensive care setting patients aged ≥ 18 years with COVID-19 acute respiratory distress syndrome were assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages and blood. Our primary outcome was ventilator-free survival on day 28 in patients with and without clinically relevant superinfection. Further outcomes included the association of superinfection with ICU length of stay, incidence of bacteremia, viral reactivations, and fungal colonization. Results In 45 critically ill COVID-19 patients, we identified 19 patients with superinfections (42.2%) by longitudinal analysis of 433 TBS, 35 BAL and 455 blood samples, respectively. On average, superinfections were detected on day 10 after ICU admission. The most frequently isolated clinically relevant bacteria were Enterobacteriaceae, Streptococcus pneumoniae, and Pseudomonas aeruginosa. Ventilator-free survival was substantially lower in patients with superinfection (subhazard ratio 0.37, 95%-CI 0.15-0.90, p=0.028). Patients with pulmonary superinfections more often had bacteraemia, virus reactivations, yeast colonization, and needed ICU treatment for a significantly longer time. Conclusions The detection of superinfections was frequent and associated with reduced ventilator-free survival. Despite empirical antibiotic therapy, superinfections lead to an extended ICU stay in COVID 19 patients. Longitudinal microbiological sampling in COVID-19 patients could allow targeted antimicrobial therapy, and therefore minimize the use of broad-spectrum and reserve antibiotics.

SARS-CoV-2 infection in cystic fibrosis: A multicentre prospective study with a control group, Italy, February-July 2020

“…aeruginosa infection in CF patients is a common finding and about 70% of cases and controls in our study had positive sputum cultures for P. aeruginosa and were treated aggressively with IV antibiotics, as per standard practice. Bacterial superinfection, with P. aeruginosa has been associated with longer duration of ventilation in critically ill COVID-19 patients [14], but this was not the case for our patients, none of whom required mechanical ventilation.…”

Characterization and eradication of the high concentration infection source of oral segment of Candida by infection examination diagnosis system

“…There are studies describing the involvement of dental caries [15][16][17][18]; in contrast, there are studies not related to dental caries [19,20]. It may be the feature of CA that discussion in [3][4][5][6][7][8][9][10][11][12] similar to VAP has generated. In these studies, there was no analysis of the infection caused by CA, the application of the antifungal agent was stopped, and there was no plan against re-infection; moreover, studies have been reported regarding the use of antifungal agents for infection in root canal (Pseudomonas [9] is treated as an important pathogenic bacteria of apical periodontitis), but there is a lack of studies on the propriety of application of the antifungal agent after disinfection, and the technique and extent of maintenance to achieve permanent prevention of transmission and full disinfection.…”

Characterization and eradication of the high concentration infection source of oral segment of Candida by infection examination diagnosis system

“…There are studies describing the involvement of dental caries [1 5-18]; in contrast, there are studies not related to dental caries [1 9, 20]. It may be the feature of CA that discussion in [3][4][5][6][7][8][9][10][11][12] similar to VAP has generated. In these studies, there was no analysis of the infection caused by CA, the application of the antifungal agent was stopped, and there was no plan against re-infection; moreover, studies have been reported regarding the use of antifungal agents for infection in root canal (Pseudomonas [9] is treated as an important pathogenic bacteria of apical periodontitis), but there is a lack of studies on the propriety of application of the antifungal agent after disinfection, and the technique and extent of maintenance to achi eve permanent prevention of transmission and full disinfection.…”

“…Furthermore, CA colonization on airway is associated with pneumonia, malignant tumors, failure of organ transplantation, ocular opacities, digestive disorders, and respirator y disorders [3][4][5][6][7][8][9][10][11]. Moreover, a recent study [12] suggested an adverse influence of COVID-19-associated pneumonia with CA, on the oral cavity, pharynx, heart, liver, spleen, central nervous system, urinary organs, eye, skin, vagina, and the endocrine system, any of which can be the cause of the infection [1,2]. This leads to a synergistic biofilm formation which causes virulence [13].…”