Impact of Bacterial Infections on COVID-19 Patients: Is Timing Important?

Abstract

Background: Along with important factors that worsen the clinical outcome of COVID-19, it has been described that bacterial infections among patients positive for a SARS-CoV-2 infection can play a dramatic role in the disease process. Co-infections or community-acquired infections are recognized within the first 48 h after the admission of patients. Superinfections occur at least 48 h after admission and are considered to contribute to a worse prognosis. Microbiologic parameters differentiate infections that happen after the fifth day of hospitalization from those appearing earlier. Specifically, after the fifth day, the detection of resistant bacteria increases and difficult microorganisms emerge. Objectives: The aim of the study was to evaluate the impact of bacterial infections in patients with COVID-19 on the length of the hospital stay and mortality. Methods: A total of 177 patients hospitalized due to COVID-19 pneumonia were consecutively sampled during the third and fourth wave of the pandemic at a University Hospital in Greece. A confirmed bacterial infection was defined as positive blood, urinary, bronchoalveolar lavage (BAL) or any other infected body fluid. Patients with confirmed infections were further divided into subgroups according to the time from admission to the positive culture result. Results: When comparing the groups of patients, those with a confirmed infection had increased odds of death (odds ratio: 3.634; CI 95%: 1.795–7.358; p < 0.001) and a longer length of hospital stay (median 13 vs. 7 days). A late onset of infection was the most common finding in our cohort and was an independent risk factor for in-hospital death. Mortality and the length of hospital stay significantly differed between the subgroups. Conclusion: In this case series, microbial infections were an independent risk factor for a worse outcome among patients with COVID-19. Further, a correlation between the onset of infection and a negative outcome in terms of non-infected, community-acquired, early hospital-acquired and late hospital-acquired infections was identified. Late hospital-acquired infections increased the mortality of COVID-19 patients whilst superinfections were responsible for an extended length of hospital stay.

Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study

“…Several factors can influence the levels of inflammatory parameters, including the hyperinflammatory response, the virulence of microbial agents, COVID-19-induced immunosuppression, the administration of corticosteroids, IL-6 inhibitors such as tocilizumab, etc. [89]. The role of different phenotypes of COVID-19-associated ARDS (CARDS), hyperinflammatory versus hypo/normo-inflammatory, is being discussed too [81].…”

“…Despite the notably elevated initial levels of PCT in patients with HAP compared to the bacterial-infection-free cohort, this biomarker exhibits limited predictive capability for superinfection, as the identification of a reasonable cut-off value remains elusive. These observations may be attributed to the administration of corticosteroids and COVID-19-induced immunosuppression [89]. Certain authors argue that PCT values have proven inadequate in confirming bacterial infection, whereas others contend that our understanding in this area remains inconclusive [55,90].…”

Evaluation of Blood Cultures from SARS-CoV-2-Positive and Negative Adult Patients

“…In parallel to the other studies, MR-CoNS (21.5%) was isolated at the highest rate from the blood samples of SARS-CoV-2 patients. In a study by Michailides et al [ 23 ] of patients with COVID-19 infection, CoNS, and K. pneumoniae , together with A. baumannii , were the most frequently isolated bacteria in early and late (> 5 days) nosocomial bacterial infections, respectively. Bahceci et al [ 24 ] isolated CoNS (31%) and A. baumannii (27.5%) at higher rates.…”

“…Bahceci et al [ 24 ] isolated CoNS (31%) and A. baumannii (27.5%) at higher rates. Michaelides et al [ 23 ] stated that a prolonged hospital stay may increase CoNS isolation due to the development of superinfections. In the current study, the MR-CoNS (21.5%) and MS-CoNS (9.9%) isolation rates were found to be higher in patients determined to be SARS-CoV-2-positive.…”

Risk Factors of Adverse Maternal Outcome among SARS-CoV-2 Infected Critically Ill Pregnant Women in Serbia

“…Pierce-Williams et al have not reported any case of maternal death [ 36 ], and therefore, this difference should be taken into consideration seriously and analysed thoroughly, since in the context of this parameter only, earlier initiation of hospitalization seems to be unbeneficial. Moreover, prolonged hospitalization is associated with the increased risk of hospital-acquired infections, especially with the late onset of infection [ 39 ], requiring strict infection control measurements and mandatory microbiological surveillance [ 40 ]. The decedent group of patients had nearly four times the number of prescribed antibiotics compared to the group of survivors, and more importantly, the incidence of nosocomial infections was significantly higher.…”