Bloodstream infections in critically ill patients with COVID‐19

Abstract

Background: Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19). Materials and methods: This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI. Results: Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall P for the dummy variable = 0.003). Conclusions: The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.

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

“…The elevated prevalence of Enterococcus spp. has been highlighted by another study investigating BSI in ICU patients with COVID-19, it is noteworthy that a high percentage of that cohort of patients also received cephalosporins as empirical treatment [28]. The majority of our patients have also received courses of broad spectrum antibiotics, in several cases without a con rmed diagnosis of nosocomial infection, and despite this large antimicrobial coverage we recorded a high incidence of infections.…”

Immunosuppressive Drugs and COVID-19: A Review

“…In contrast, two retrospective cohort studies found that steroid use was associated with detrimental outcome ( Giacobbe et al., 2020 ; Mo et al., 2020 ). The first study included COVID-19 patients who were admitted to the ICU.…”

“…The first study included COVID-19 patients who were admitted to the ICU. They found that methylprednisolone use was independently associated with development of a blood stream infection ( Giacobbe et al., 2020 ). Another retrospective cohort study found that patients treated with steroids were less likely to reach clinical and radiological remission within 10 days than patients who did not use steroids ( Mo et al., 2020 ).…”

Severe COVID‐19 and interleukin‐6 receptor antagonist tocilizumab: Some notes of concern

“…On the other hand, the risk of bacterial infection may be higher in the ICU setting, where more frequent use of vascular and other indwelling devices represent a risk for bloodstream infections (BSI), which are also often reported in patients with COVID-19. 5 Moreover, the use of antiinflammatory agents in the ICU setting, including tocilizumab, was associated with a higher risk of developing BSI, especially when used in combination with methylprednisolone. Considering the lack of convincing evidence on the clinical improvement of critically ill patients treated with IL-6RA, the risks might outweigh the benefits in the critical setting.…”