High rate of infections during ICU admission of patients with severe SARS-CoV-2 pneumonia: A matter of time?

Barrasa, Helena; Martín, Alejandro Herrero-San; Maynar, Javier; Rello, Jordi; Fernández-Torres, Marina; Aguirre-Quiñonero, Amaia; Canut, Andrés; Investigators, Alava Covid Study

doi:10.1016/j.jinf.2020.12.001

Cited by 16 publications

(14 citation statements)

References 10 publications

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“…Previously a Spanish study on 24 subjects found most common isolates were S. aureus, S. pneumoniae, and H . influenzae [9]. Other studies also showed most common isolate was S .…”

Section: Discussionmentioning

confidence: 94%

A comparative study of Bacterial culture isolates, site of infections and drug resistance pattern between COVID and non COVID patients admitted in a tertiary care hospital: A Pilot study

Ak¹,

Mukherjee²,

Seal³

et al. 2021

Preprint

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Introduction: SARS-CoV2 which is a corona virus also predisposes patient to secondary bacterial infection by various mechanisms like- damaging the respiratory epithelium, profoundly affecting the innate and adaptive immunity, antagonising Interferon responses that enhance bacterial adherence, colonisation and invasion to respiratory tissue. In addition, prolonged hospital stay, invasive therapeutic devices, widespread use of empiric antibiotics and most importantly use of immune-suppressants like Steroid or Tocilizumab further increases the chances of bacterial infection. As opposed to this concept- physical distancing, frequent hand washing and use of gloves and protective gear by the healthcare workers also diminishes the chance of secondary bacterial infection. The present study is done to delineate the bacteriological profile, infection site predisposition or to gain knowledge on antibiotic sensitivity pattern. Method : Retrospective data will be analyzed from June 2020, when the first COVID wave came to June 2021, corresponding to second COVID wave. The present study is a pilot study before collecting and analyzing the whole data Only those samples which were positive for bacterial isolates were randomly selected and the COVID status and drug resistance patterns were checked. Results and discussion: The most common organism found was Klebsiella. Acinetobacter was also found in few patients. But most striking finding was that COVID positive patients showed higher incidence of antibiotic resistance with Acinetobacter. Though E Coli was also found commonly in COVID positive patients, they were not drug resistant. Conclusion: MDR infections are common in COVID patients. Acinetobacter and Klebsiella are prone to develope MDR infections. While E.Coli is also common in COVID patients, chance of drug resistance is less among them.

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“…Previously a Spanish study on 24 subjects found most common isolates were S. aureus, S. pneumoniae, and H . influenzae [9]. Other studies also showed most common isolate was S .…”

Section: Discussionmentioning

confidence: 94%

A comparative study of Bacterial culture isolates, site of infections and drug resistance pattern between COVID and non COVID patients admitted in a tertiary care hospital: A Pilot study

Ak¹,

Mukherjee²,

Seal³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…However, in a number of the studies described above, patients had been symptomatic for several days before hospital admission and spent several hours in hospital before intubation, so these cannot truly be labelled co-infections and may well be superinfections. Lastly, a prospective study of patients admitted to a Spanish ICU, reported both early infections (on admission or within 48 h of admission to the ICU) and later infections in 92 patients [40]. Overall, 32 microbial isolates were found within 48 h in 24 patients (26%, 24/ 92), most commonly S. aureus, S. pneumoniae, and H. influenzae.…”

Section: Letters To the Editor Including Research Lettersmentioning

confidence: 99%

The role of co-infections and secondary infections in patients with COVID-19

2021

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Background It has been recognised for a considerable time-period, that viral respiratory infections predispose patients to bacterial infections, and that these co-infections have a worse outcome than either infection on its own. However, it is still unclear what exact roles co-infections and/or superinfections play in patients with COVID-19 infection. Main body This was an extensive review of the current literature regarding co-infections and superinfections in patients with SARS-CoV-2 infection. The definitions used were those of the Centers for Disease Control and Prevention (US), which defines coinfection as one occurring concurrently with the initial infection, while superinfections are those infections that follow on a previous infection, especially when caused by microorganisms that are resistant, or have become resistant, to the antibiotics used earlier. Some researchers have envisioned three potential scenarios of bacterial/SARS-CoV-2 co-infection; namely, secondary SARS-CoV-2 infection following bacterial infection or colonisation, combined viral/bacterial pneumonia, or secondary bacterial superinfection following SARS-CoV-2. There are a myriad of published articles ranging from letters to the editor to systematic reviews and meta-analyses describing varying ranges of co-infection and/or superinfection in patients with COVID-19. The concomitant infections described included other respiratory viruses, bacteria, including mycobacteria, fungi, as well as other, more unusual, pathogens. However, as will be seen in this review, there is often not a clear distinction made in the literature as to what the authors are referring to, whether true concomitant/co-infections or superinfections. In addition, possible mechanisms of the interactions between viral infections, including SARS-CoV-2, and other infections, particularly bacterial infections are discussed further. Lastly, the impact of these co-infections and superinfections in the severity of COVID-19 infections and their outcome is also described. Conclusion The current review describes varying rates of co-infections and/or superinfections in patients with COVID-19 infections, although often a clear distinction between the two is not clear in the literature. When they occur, these infections appear to be associated with both severity of COVID-19 as well as poorer outcomes.

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“…The co-infection rates in COVID-19 seem to be lower than those reported for influenza pandemics [8,9]. The main pathogens associated with co-infections are S. aureus, S. pneumoniae and H. influenzae [4,6,10], while in some studies S. pneumoniae takes a minor role [7,8,[10][11][12].…”

Section: Introductionmentioning

confidence: 93%

“…The causes contributing to mortality are respiratory failure with severe hypoxemia and its immediate consequences, multiorgan failure, thromboembolism, hemorrhage, and healthcare-associated infections (HAIs) associated with bacteria and filamentous fungi. Bacterial co-infections, diagnosed around the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, appear to be uncommon, occurring in 0.6 to 3.2% of patients [3], although some studies reported higher rates, reaching 26-28% [4][5][6] or more [7]. The co-infection rates in COVID-19 seem to be lower than those reported for influenza pandemics [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Outbreaks of multidrug resistant bacteria are also commonly reported, including a variety of organisms such as carbapenem resistant Acinetobacter baumannii, carbapenem resistant Enterobacterales, multidrug resistant Pseudomonas aeruginosa, methicillin resistant Staphylococcus aureus (MRSA), Candida auris and others [2,[16][17][18]. Since most COVID-19 patients in the ICUs are treated empirically with antimicrobials [4,19], antibiotic stewardship programs along with enhanced infection control protocols are essential in controlling the emergence of these dreaded infections.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background: The role of bacterial co-infection and superinfection among critically ill COVID-19 patients remains unclear. The aim of this study was to assess the rates and characteristics of pulmonary infections, and associated outcomes of ventilated patients in our facility. Methods: This was a retrospective study of ventilated COVID-19 patients between March 2020 and March 2021 that underwent BioFire®, FilmArray® Pneumonia Panel, testing. Community-acquired pneumonia (CAP) was defined when identified during the first 72 h of hospitalization, and ventilator-associated pneumonia (VAP) when later. Results: 148 FilmArray tests were obtained from 93 patients. With FilmArray, 17% of patients had CAP (16/93) and 68% had VAP (64/93). Patients with VAP were older than those with CAP or those with no infection (68.5 vs. 57–59 years), had longer length of stay and higher mortality (51% vs. 10%). The most commonly identified FilmArray target organisms were H. influenzae, S. pneumoniae, M. catarrhalis and E. cloacae for CAP and P. aeruginosa and S. aureus for VAP. FilmArray tests had high negative predictive values (99.6%) and lower positive predictive values (~60%). Conclusions: We found high rates of both CAP and VAP among the critically ill, caused by the typical and expected organisms for both conditions. VAP diagnosis was associated with poor patient outcomes.

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High rate of infections during ICU admission of patients with severe SARS-CoV-2 pneumonia: A matter of time?

Cited by 16 publications

References 10 publications

A comparative study of Bacterial culture isolates, site of infections and drug resistance pattern between COVID and non COVID patients admitted in a tertiary care hospital: A Pilot study

A comparative study of Bacterial culture isolates, site of infections and drug resistance pattern between COVID and non COVID patients admitted in a tertiary care hospital: A Pilot study

The role of co-infections and secondary infections in patients with COVID-19

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

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