Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients

Abstract

Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.

Predictors and Outcomes of Healthcare-Associated Infections among Patients with COVID-19 Admitted to Intensive Care Units in Punjab, Pakistan; Findings and Implications

“…Similarly, Falcone et al (2020) reported high rates at 71.6% among patients with COVID-19 admitted to ICUs in participating Italian hospitals [ 64 ]. Our findings also contrast with those of Ghali et al (2021) in Tunisia where HAIs were seen in 35.1% of patients in ICU with COVID-19 [ 24 ], and with de Hesselle et al (2022) among patients critically ill in ICUs enrolled into the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) study [ 27 ]. Secondary bacterial infections were documented in the critical phase in 40.4% of cases in this study, and secondary fungal infections in 14.6% of cases [ 27 ].…”

“…Our findings also contrast with those of Ghali et al (2021) in Tunisia where HAIs were seen in 35.1% of patients in ICU with COVID-19 [ 24 ], and with de Hesselle et al (2022) among patients critically ill in ICUs enrolled into the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) study [ 27 ]. Secondary bacterial infections were documented in the critical phase in 40.4% of cases in this study, and secondary fungal infections in 14.6% of cases [ 27 ]. Other studies though have recorded appreciably higher rates with up to 68% of patients in ICUs acquiring secondary bacterial infections during their stay, principally secondary pneumonia [ 65 ].…”

“…HAIs can develop in a hospital setting in patients receiving health care after 48 h or more after hospital admission [ 23 , 24 ]. Invasive devices, which include vascular devices, urinary catheters and ventilators employed in the medical care of patients, are associated with these HAIs [ 25 , 26 , 27 ]. The risk of HAI transmission is increased with the lack of awareness and training among health care providers especially in LMICs [ 28 , 29 , 30 , 31 , 32 ].…”

Characteristics of unvaccinated and vaccinated critically ill COVID-19 patients in calabria region (Italy): A retrospective study

“…By a mathematical model, it is well known that the vaccination program has altered the course of COVID-19, reducing the related mortality already after the first year of vaccine program ( 34 ). Furthermore, the impact of MDR and fungal superinfections has increased from the beginning of the pandemic, severely afflicting the survival rate of critically ill COVID-19 patients ( 35 – 38 ).…”

Multidrug-resistant infection in COVID-19 patients: A meta-analysis

“…General information about the included studies is summarized( Table 1 ). 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 We focused on collecting some of the most common strains, such as Enterobacter, S. aureus , and Klebsiella pneumoniae . The results of eight studies were showed that 42% of the patients with COVID-19 were infected with MDR (95% confidence interval (CI), 0.23–0.61; P < 0.01) ( Figure 1 ).…”