Factors related to <scp>COVID</scp>‐19 mortality among three <scp>Swedish</scp> intensive care units—A retrospective study

Taxbro, Knut; Hammarskjöld, Fredrik; Nilsson, Mats; Persson, Mats A. A.; Chew, Michelle; Sunnergren, Ola

doi:10.1111/aas.14232

Cited by 4 publications

(1 citation statement)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,[12][13][14]36 It is worth noting that the overall mortality rate among C-ARDS patients in our study was relatively low (12%), which makes it challenging to evaluate superinfection and VAP as risk factors for death. 16 The study has several limitations. First, the retrospective singlecentre design reduces generalizability.…”

Section: Streptococcus Agalactiaementioning

confidence: 98%

Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single‐centre study

Hammarskjöld,

Berg,

Bavelaar

et al. 2024

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

BackgroundPatients with severe coronavirus disease 2019 (COVID) pneumonia and acute respiratory distress syndrome (C‐ARDS) on invasive mechanical ventilation (IMV) have been found to be prone to having other microbial findings than severe acute respiratory syndrome coronavirus 2 (SARS‐2)‐CoV‐19 in the bronchoalveolar lavage (BAL) fluid at intubation causing a superinfection. These BAL results could guide empirical antibiotic treatment in complex clinical situations. However, there are limited data on the relationship between microbial findings in the initial BAL at intubation and later ventilator‐associated pneumonia (VAP) diagnoses.ObjectiveTo analyse the incidence of, and microorganisms responsible for, superinfections in C‐ARDS patients at the time of first intubation through microbial findings in BAL fluid. To correlate these findings to markers of inflammation in plasma and later VAP development.DesignRetrospective single‐centre study.SettingOne COVID‐19 intensive care unit (ICU) at a County Hospital in Sweden during the first year of the pandemic.PatientsAll patients with C‐ARDS who were intubated in the ICU.ResultsWe analysed BAL fluid specimens from 112 patients at intubation, of whom 31 (28%) had superinfections. Blood levels of the C‐reactive protein, procalcitonin, neutrophil granulocytes, and lymphocytes were indistinguishable between patients with and without a pulmonary superinfection. Ninety‐eight (88%) of the patients were treated with IMV for more than 48 h and of these patients, 37% were diagnosed with VAP. The microorganisms identified in BAL at the time of intubation are normally found at the oral, pharyngeal, and airway sites. Only one patient had an indistinguishable bacterial strain responsible for both superinfection at intubation and in VAP.ConclusionsOne fourth of the patients with C‐ARDS had a pulmonary superinfection in the lungs that was caused by another microorganism identified at intubation. Routine serum inflammatory markers could not be used to identify this complication. Microorganisms located in BAL at intubation were rarely associated with later VAP development.

show abstract

Section: Streptococcus Agalactiaementioning

confidence: 98%

Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single‐centre study

Hammarskjöld,

Berg,

Bavelaar

et al. 2024

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

show abstract

Intensive care unit-acquired infections more common in patients with COVID-19 than with influenza

Beck-Friis,

Gisslén,

Nilsson

et al. 2024

Sci Rep

View full text Add to dashboard Cite

Intensive care unit-acquired infections are complicating events in critically ill patients. In this study we analyzed the incidence, microbiological patterns, and outcome in patients with COVID-19 versus influenza in the intensive care unit (ICU). We included all adult patients treated with invasive mechanical ventilation due to (1) COVID-19 between January 2020 and March 2022, and (2) influenza between January 2015 and May 2023 at Sahlgrenska University Hospital, Sweden. Of the 480 participants included in the final analysis, 436 had COVID-19. The incidence rates of ICU-acquired infections were 31.6/1000 and 9.9/1000 ICU-days in the COVID-19 and influenza cohorts, respectively. Ventilator-associated lower respiratory tract infections were most common in both groups. In patients with COVID-19, corticosteroid treatment was associated with an increased risk of ICU-acquired infections and with higher 90-day mortality in case of infection. Furthermore, ICU-acquired infection was associated with a prolonged time in the ICU, with more difficult-to-treat gram-negative infections in late versus early ventilator-associated lower respiratory tract infections. Further research is needed to understand how the association between corticosteroid treatment and incidence and outcome of ICU-acquired infections varies across different patient categories.

show abstract

Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden

Forsberg,

Taxbro,

Elander

et al. 2023

Acta Anaesthesiol Scand

Self Cite

View full text Add to dashboard Cite

BackgroundVentilator‐associated lower respiratory tract infections (VA‐LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA‐LRTI have been reported among COVID‐19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA‐LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID‐19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA‐LTRI on morbidity and mortality.MethodsWe conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID‐19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA‐LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA‐LRTI.ResultsOf a total of 536 included patients, 153 (28.5%) developed VA‐LRTI. Incidence rate of first VA‐LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA‐LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA‐LRTI had fewer ventilator‐free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds‐ratio (aOR) for first VA‐LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31–5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14–3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03–1.07]). Few multidrug‐resistant pathogens were identified. Incidence of VA‐LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves.ConclusionWe report a high incidence of culture‐verified VA‐LRTI in a cohort of critically ill COVID‐19 patients from the first three pandemic waves. VA‐LRTI was associated with increased morbidity but not 30‐, 60‐, or 90‐day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA‐LRTI.

show abstract

Factors related to COVID‐19 mortality among three Swedish intensive care units—A retrospective study

Cited by 4 publications

References 30 publications

Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single‐centre study

Pulmonary superinfection diagnosed with bronchoalveolar lavage at intubation in COVID patients: A Swedish single‐centre study

Intensive care unit-acquired infections more common in patients with COVID-19 than with influenza

Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden

Contact Info

Product

Resources

About