ICU-acquired bloodstream infections in critically ill patients with COVID-19

Kokkoris, Stelios; Papachatzakis, Ioannis; Gavrielatou, Evdokia; Ntaidou, Theodora K.; Ischaki, Eleni; Malachias, Sotirios; Vrettou, CS; Nichlos, C.; Kanavou, Aggeliki; Zervakis, Dimitrios; Perivolioti, Efstathia; Ranellou, Kyriaki; Argyropoulou, Athina; Zakynthinos, Spyros; Κοτανίδου, Αναστασία; Routsi, Christina

doi:10.1016/j.jhin.2020.11.009

Cited by 56 publications

(62 citation statements)

References 8 publications

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“…Additional evidence has demonstrated the horizontal transfer of ARGs, including methicillin resistance, from S. epidermidis to S. aureus 48 – 50 , a known formidable, virulent nosocomial pathogen. Our findings also agree with two independent studies that consistently reported a high incidence of ICU-acquired BSIs (51.2%–54%) in severely ill COVID-19 patients, mostly due to MDR pathogens 40 , 51 .…”

Section: Discussionsupporting

confidence: 93%

“…(including M. hominis and M. orale ). These organisms are distinct from prior results on pathogenic bacteria identified in previous coronavirus outbreak and influenza pandemics (e.g., S. pneumoniae , S. aureus , K. pneumoniae , and M. pneumoniae ) 4 – 8 or those associated with ICU-acquired bloodstream infections (BSIs) ( Acinetobacter baumannii , K. pneumoniae , Enterococcus spp ., Candida albicans , and C. parapsilosis ) in a cohort of 50 severely ill COVID-19 patients in Athens, Greece 40 . A strong confounding factor in this study is the markedly different treatment instigated for the mild and severe cases, where multiple and broad-spectrum antimicrobial agents were given to severe cases but not mild cases.…”

Section: Discussionmentioning

confidence: 99%

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Characterization of respiratory microbial dysbiosis in hospitalized COVID-19 patients

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic of Coronavirus disease 2019 (COVID-19). However, the microbial composition of the respiratory tract and other infected tissues as well as their possible pathogenic contributions to varying degrees of disease severity in COVID-19 patients remain unclear. Between 27 January and 26 February 2020, serial clinical specimens (sputum, nasal and throat swab, anal swab and feces) were collected from a cohort of hospitalized COVID-19 patients, including 8 mildly and 15 severely ill patients in Guangdong province, China. Total RNA was extracted and ultra-deep metatranscriptomic sequencing was performed in combination with laboratory diagnostic assays. We identified distinct signatures of microbial dysbiosis among severely ill COVID-19 patients on broad spectrum antimicrobial therapy. Co-detection of other human respiratory viruses (including human alphaherpesvirus 1, rhinovirus B, and human orthopneumovirus) was demonstrated in 30.8% (4/13) of the severely ill patients, but not in any of the mildly affected patients. Notably, the predominant respiratory microbial taxa of severely ill patients were Burkholderia cepacia complex (BCC), Staphylococcus epidermidis, or Mycoplasma spp. (including M. hominis and M. orale). The presence of the former two bacterial taxa was also confirmed by clinical cultures of respiratory specimens (expectorated sputum or nasal secretions) in 23.1% (3/13) of the severe cases. Finally, a time-dependent, secondary infection of B. cenocepacia with expressions of multiple virulence genes was demonstrated in one severely ill patient, which might accelerate his disease deterioration and death occurring one month after ICU admission. Our findings point to SARS-CoV-2-related microbial dysbiosis and various antibiotic-resistant respiratory microbes/pathogens in hospitalized COVID-19 patients in relation to disease severity. Detection and tracking strategies are needed to prevent the spread of antimicrobial resistance, improve the treatment regimen and clinical outcomes of hospitalized, severely ill COVID-19 patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Characterization of respiratory microbial dysbiosis in hospitalized COVID-19 patients

et al. 2021

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“…The finding of an expenditure for liposomal amphotericin B in the COVID-ICU ward that is not comparable with the other two cohorts confirms the data of a higher frequency of fungal isolations in patients with COVID-19, in agreement with what was reported by other authors [ 35 , 36 , 37 ].…”

Section: Discussionsupporting

confidence: 87%

Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings

Cultrera

Barozzi

Libanore

et al. 2021

IJERPH

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Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group.

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“…Common respiratory bacteria more often cause infection in early stages of the illness [75,125,129,133,[141][142][143]. Nosocomial infections can be common as the viral illness progresses albeit the institutional rate is quite variable [49,118,119,123,131,[135][136][137][138][139][140][144][145][146][147]. Much of the latter includes opportunistic Gram-negative bacilli [49,100,118,119,123,124,126,137,138,140,144,145,147,148].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Inmentioning

confidence: 99%

“…Nosocomial infections can be common as the viral illness progresses albeit the institutional rate is quite variable [49,118,119,123,131,[135][136][137][138][139][140][144][145][146][147]. Much of the latter includes opportunistic Gram-negative bacilli [49,100,118,119,123,124,126,137,138,140,144,145,147,148]. Fungal infections, especially with Candida spp., occur with worse disease and increased hospital stay [118,126,135,136,139,144,145,147,[149][150][151].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Inmentioning

confidence: 99%

The Complexity of Co-Infections in the Era of COVID-19

Cimolai

2021

SN Compr. Clin. Med.

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ICU-acquired bloodstream infections in critically ill patients with COVID-19

Cited by 56 publications

References 8 publications

Characterization of respiratory microbial dysbiosis in hospitalized COVID-19 patients

Characterization of respiratory microbial dysbiosis in hospitalized COVID-19 patients

Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings

The Complexity of Co-Infections in the Era of COVID-19

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