Incidence and clinical outcomes of bacterial superinfections in critically ill patients with COVID-19

Abstract

BackgroundBacterial superinfection is not uncommon in critically ill patients with coronavirus disease (COVID-19) pneumonia requiring intensive care unit (ICU) treatment. However, there is still a lack of evidence related to bacterial superinfection and their clinical significance in critically ill patients with COVID-19. Therefore, we assessed the incidence of bacterial superinfections and their effects on clinical outcomes in critically ill patients with COVID-19.Materials and methodsThis single-center retrospective cohort study analyzed critically ill patients with COVID-19 admitted to the ICU at a tertiary academic hospital between February 2020 and December 2021. We reviewed data including patient demographics, clinical and microbiological characteristics, and outcomes.ResultsDuring the study period, 106 patients (median [IQR] age, 67 [58–75] years) were included, of which 32 (30%) were diagnosed with bacterial superinfections. Of these, 12 cases (38%) were associated with multidrug-resistant pathogens. Klebsiella aerogenes (6 cases [19%]) and Klebsiella pneumoniae (6 cases [19%]) were the most common pathogens associated with superinfections. The median time to bacterial superinfection was 13 (IQR, 9–20) days after ICU admission. Patients with bacterial superinfections had significantly fewer ventilator-free days on day 28 (0 [IQR, 0–0] days) than those without bacterial superinfections (19 [IQR, 0–22] days) (p < 0.001). Patients with bacterial superinfections had a longer ICU length of stay (32 [IQR, 9–53] days) than those without bacterial superinfections (11 [IQR, 7–18] days) (p < 0.001). Additionally, they had a longer hospital length of stay after ICU admission (39 [IQR, 18–62] days) than those without bacterial superinfections (18 [IQR, 12–37] days) (p = 0.001). There were no differences in ICU mortality or in-hospital mortality between the two groups. In the multivariable analysis, higher SAPS II score (OR, 2.697; 95% CI, 1.086–6.695) and thrombocytopenia (OR, 3.318; 95% CI, 1.355–8.123) were identified as risk factors for development of bacterial superinfection.ConclusionIn critically ill patients with COVID-19, bacterial superinfections were common, and more than one-third of the bacterial superinfection cases were caused by multidrug-resistant pathogens. As patients with bacterial superinfections had worse clinical outcomes, the development of bacterial superinfections should be actively monitored.

Trajectories and predictive significance of inflammatory parameters for clinical outcome in COVID-19 patients treated with tocilizumab

“…We report a rate of bacterial superinfection of 35.5% after tocilizumab treatment, which is associated with a higher mortality. This is within the range of reported superinfection rates: Yoon et al report 30% of superinfections in patients with COVID-19 and intensive care unit (ICU) treatment [32], a Norwegian study showed a superinfection rate of 43% [33] in patients treated with dexamethasone. We observed a higher rate of antibiotic use compared to microbiological evidence of superinfection, consistent with studies demonstrating antibiotic overuse, partly attributed to the signi cant increase of in ammatory markers inherent to COVID-19 but often misinterpreted as evidence of bacterial superinfection [34].…”

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

“…The fact that the incidences of bacterial respiratory co-infections and superinfections increase significantly with the severity of the disease is confirmed by other authors [17,[21][22][23][24][25][26][27]. In patients requiring ICU care, the incidence of bacterial respiratory co-infection or CAP is reported to be 14-41%, and the incidence of bacterial lung superinfection or HAP ranges between 14-40% [24,[27][28][29][30][31][32][33][34]. What is more, in patients with severe or critical stages of COVID-19, the risk for poor outcomes also increases significantly [15,21,22,29].…”

Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia

“…In a study including 989 patients, Garcia-Vidal et al [ 5 ] showed that patients with CP and superinfection had a significantly prolonged length of stay in the hospital and higher mortality. Falcone et al [ 25 ] and Yoon et al [ 39 ] also showed a significantly prolonged length of stay for patients with CP and superinfection but no significant association between superinfection and mortality in these patients. Wallemacq et al [ 40 ] demonstrated an increased mortality in CP patients compared to IP patients independent of bacterial superinfection, which, according to the authors, suggests that the increased mortality rate in CP is not related to secondary complications but is likely due to the severity of the disease.…”