COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital

Ramos, Rafael; Villa, Sofía de la; García-Ramos, Sergio; Padilla, Belén; García-Olivares, Pablo; Piñero, Patricia; Garrido, Alberto; Hortal, Javier; Muñóz, Patricia; Caamaño, Estrela; Benito, Pilar; Cedeño, Jamil; Garutti, Ignacio

doi:10.1016/j.eimc.2021.10.014

Cited by 19 publications

(22 citation statements)

References 27 publications

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“…Early (in the first 48 h from admission) use of systemic corticosteroids was associated with a shorter interval between admission and occurrence of BSI, and with a significantly higher risk of antimicrobial resistance. These findings are consistent with the increased risk of secondary infections described in patients with COVID-19 receiving corticosteroid treatment ( 4 , 26 , 27 ). This increased susceptibility to infections may, however, not necessarily translate in increased mortality: use of steroids might have beneficial effects in patients with ARDS, with and without COVID-19 ( 28 ), and may actually reduce mortality in patients with critical illness ( 29 , 30 ).…”

Section: Discussionsupporting

confidence: 87%

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

Monaco

Floridia²,

Giuliano³

et al. 2022

Front. Med.

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IntroductionIn hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance.MethodsHospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses.ResultsThe study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018).ConclusionsIn patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.

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Section: Discussionsupporting

confidence: 87%

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

Monaco

Floridia²,

Giuliano³

et al. 2022

Front. Med.

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“…Nosocomial infections have been described in admitted COVID-19 patients, particularly in critically ill subjects. Our institution reported that superinfections occurred in 44.6% of the ICU COVID-19 patients [ 32 ]. BSIs (particularly bacterial) are one of the most frequent types of infection in this setting, with a reported incidence rate of 47 episodes (95% confidence interval (CI) 35–63) per 1000 patient-days at risk [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Candidemia Is Higher in COVID-19 versus Non-COVID-19 Patients, but Not Driven by Intrahospital Transmission

Machado

Estévez

Sánchez‐Carrillo

et al. 2022

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There is scarce information on the actual incidence of candidemia in COVID-19 patients. In addition, comparative studies of candidemia episodes in COVID-19 and non-COVID-19 patients are heterogeneous. Here, we assessed the real incidence, epidemiology, and etiology of candidemia in COVID-19 patients, and compared them with those without COVID-19 (2020 vs. 2019 and 2020, respectively). We also genotyped all C. albicans, C. parapsilosis, and C. tropicalis isolates (n = 88), causing candidemia in both groups, providing for the first time a genotypic characterization of isolates gathered in patients with either COVID-19 or non-COVID-19. Incidence of candidemia was higher in patients with COVID-19 than non-COVID-19 (4.73 vs. 0.85 per 1000 admissions; 3.22 vs. 1.14 per 10,000 days of stay). No substantial intergroup differences were found, including mortality. Genotyping proved the presence of a low number of patients involved in clusters, allowing us to rule out rampant patient-to-patient Candida transmission. The four patients, involved in two clusters, had catheter-related candidemia diagnosed in the first COVID-19 wave, which demonstrates breaches in catheter management policies occurring in such an overwhelming situation. In conclusion, the incidence of candidemia in patients with COVID-19 is significantly higher than in those without COVID-19. However, genotyping shows that this increase is not due to uncontrolled intrahospital transmission.

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“…In particular, the incidence of secondary pulmonary infections in hospitalized patients was reported to be 16% (4.8–42.8%) and 6.3% (0.9–33.3%) for bacterial and fungal infections, respectively [ 10 ]. In critically ill patients, the incidence of superinfections is much higher, reaching up to 45% of cases [ 15 , 16 , 17 , 18 ], and is constituted mostly of pneumonia (50%) and bloodstream infections (34%) [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

et al. 2022

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Background: Bacterial and fungal co-infections and superinfections have a critical role in the outcome of the COVID-19 patients admitted to the Intensive Care Unit (ICU). Methods: The present study is a retrospective analysis of 95 patients admitted to the ICU for COVID-19-related ARDS during the first (February–May 2020) and second waves of the pandemic (October 2020–January 2021). Demographic and clinical data, CT imaging features, and pulmonary and extra-pulmonary complications were recorded, as well as the temporal evolution of CT findings when more than one scan was available. The presence of co-infections and superinfections was registered, reporting the culprit pathogens and the specimen type for culture. A comparison between patients with and without bacterial and/or co-infections/superinfections was performed. Results: Sixty-three patients (66.3%) developed at least one confirmed co-infection/superinfection, with 52 (82.5%) developing pneumonia and 43 (68.3%) bloodstream infection. Gram-negative bacteria were the most common co-pathogens identified and Aspergillus spp. was the most frequent pulmonary microorganism. Consolidations, cavitations, and bronchiectasis were significantly associated with the presence of co-infections/superinfections (p = 0.009, p = 0.010 and p = 0.009, respectively); when considering only patients with pulmonary co-pathogens, only consolidations remained statistically significative (p = 0.004). Invasive pulmonary aspergillosis was significantly associated with the presence of cavitations and bronchiectasis (p < 0.001). Patients with co-infections/superinfections presented a significantly higher mortality rate compared to patients with COVID-19 only (52.4% vs. 25%, p = 0.016). Conclusions: Bacterial and fungal co-infections and superinfections are frequent in COVID-19 patients admitted to ICU and are associated with worse outcomes. Imaging plays an important role in monitoring critically ill COVID-19 patients and may help detect these complications, suggesting further laboratory investigations.

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COVID-19 associated infections in the ICU setting: A retrospective analysis in a tertiary-care hospital

Cited by 19 publications

References 27 publications

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020–2021)

Incidence of Candidemia Is Higher in COVID-19 versus Non-COVID-19 Patients, but Not Driven by Intrahospital Transmission

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

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