&lt;p&gt;Analysis of the Risk Factors for Nosocomial Bacterial Infection in Patients with COVID-19 in a Tertiary Hospital&lt;/p&gt;

Keping, Cheng; He, Miao; Qin, Shu; Wu, Ming; Cui-fang, Chen; Xue, Yulei

doi:10.2147/rmhp.s277963

Cited by 36 publications

(33 citation statements)

References 32 publications

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“…Reports of rates of VAP amongst ventilated patients with COVID-19 vary, with rates of 40–86% reported [ 38 – 40 ] and our reported rate of 49% is in keeping with reports from other centres. Although some reports, not focussed specifically on VAP, indicate lower rates of 10% [ 8 ], it is unclear how many of the ICU patients in that cohort were ventilated for at least 48 h. The rates of VAP between centres managing COVID-19 are likely to vary depending on the clinical characteristics of the patients managed, differential ICU admissions policies and clinical factors such as use of immunosuppressive therapies.…”

Section: Discussionsupporting

confidence: 90%

Ventilator-associated pneumonia in critically ill patients with COVID-19

et al. 2021

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Background Pandemic COVID-19 caused by the coronavirus SARS-CoV-2 has a high incidence of patients with severe acute respiratory syndrome (SARS). Many of these patients require admission to an intensive care unit (ICU) for invasive ventilation and are at significant risk of developing a secondary, ventilator-associated pneumonia (VAP). Objectives To study the incidence of VAP and bacterial lung microbiome composition of ventilated COVID-19 and non-COVID-19 patients. Methods In this retrospective observational study, we compared the incidence of VAP and secondary infections using a combination of microbial culture and a TaqMan multi-pathogen array. In addition, we determined the lung microbiome composition using 16S RNA analysis in a subset of samples. The study involved 81 COVID-19 and 144 non-COVID-19 patients receiving invasive ventilation in a single University teaching hospital between March 15th 2020 and August 30th 2020. Results COVID-19 patients were significantly more likely to develop VAP than patients without COVID (Cox proportional hazard ratio 2.01 95% CI 1.14–3.54, p = 0.0015) with an incidence density of 28/1000 ventilator days versus 13/1000 for patients without COVID (p = 0.009). Although the distribution of organisms causing VAP was similar between the two groups, and the pulmonary microbiome was similar, we identified 3 cases of invasive aspergillosis amongst the patients with COVID-19 but none in the non-COVID-19 cohort. Herpesvirade activation was also numerically more frequent amongst patients with COVID-19. Conclusion COVID-19 is associated with an increased risk of VAP, which is not fully explained by the prolonged duration of ventilation. The pulmonary dysbiosis caused by COVID-19, and the causative organisms of secondary pneumonia observed are similar to that seen in critically ill patients ventilated for other reasons.

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Section: Discussionsupporting

confidence: 90%

Ventilator-associated pneumonia in critically ill patients with COVID-19

et al. 2021

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“…However, secondary bacterial infections occur in an appreciable number of critically ill, hospitalized patients, since risk factors for nosocomial infections such as prolonged mechanical ventilation are prominent features of severe disease [ 17 , 18 ]. Bacterial pneumonia, especially ventilator-associated pneumonia, is the most common secondary bacterial infection, but patients with severe COVID-19 are also susceptible to urinary tract and bloodstream infections [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

et al. 2021

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Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection. Methods We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated. Results Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%. Conclusion PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

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“…In addition, we also confirmed that infections are not only caused by respiratory superinfection. There is an important rate of primary and catheter-related bacteremias, urinary tract and abdominal infections, with a significant rate of gram-positive cocci, enterobacterial, non-fermentative and multiresistant pathogens [ 14 , 17 , 18 ]. These are not surprising data since COVID-19 actually can result in long hospital stays, ICU admission, vascular and respiratory devices, malnutrition and a wider use of empirical antibiotherapy, all well-known risk factors for nosocomial infection [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Bacterial infections in patients hospitalized with COVID-19

et al. 2021

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Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.

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<p>Analysis of the Risk Factors for Nosocomial Bacterial Infection in Patients with COVID-19 in a Tertiary Hospital</p>

Cited by 36 publications

References 32 publications

Ventilator-associated pneumonia in critically ill patients with COVID-19

Ventilator-associated pneumonia in critically ill patients with COVID-19

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

Bacterial infections in patients hospitalized with COVID-19

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