Nosocomial infections associated to COVID-19 in the Intensive Care Unit. Clinical characteristics and outcome

Abstract

Background: Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients.Aim: To assess the characteristics and outcome of ICU-acquired infections in COVID-19 patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%) and urinary tract infection (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.

Nosocomial infections among COVID-19 patients: an analysis of intensive care unit surveillance data

“…COVID-19 patients seem to be more predisposed to catheter-associated urinary tract infection (CAUTI) potentially due to longer duration of indwelling urinary catheter-days despite a higher proportion of non-COVID-19 patients having urinary catheters. Moreover, our study also reflected a relatively low ICU nosocomial infection (8.5%) compared to other studies [ 2 , 3 , 10 , 11 ], which ranges from 7.2 to 46% co-infection in critically ill COVID-19 patients. Nosocomial infections in critically ill COVID-19 patients are also known to have poorer mortality, often requiring intensive care [ 2 , 3 , 10 , 11 ].…”

Clinical course and outcomes of critically ill COVID-19 patients in two successive pandemic waves

“…Also, the cumulative risk of secondary sepsis increases with ICU stay (38), and bacterial DNA and toxins have been discovered in all severely ill patients with COVID-19 (39,40). Until now, clinically relevant sepsis and septic shock have been reported in up to 60% of cases, which is in accordance with our results (first wave 47%, second wave 50%) (41,42). On the other hand, respiratory failure and MODS were key determinants of survival during the second wave.…”

Clinical characteristics, management practices, and outcomes among lung transplant patients with COVID-19

“…Besides, most patients (n=17) were unable to provide respiratory specimen and were being treated with higher dose corticosteroids which could increase the risk of secondary bacterial infections. Regardless, the strategy of prophylactic antibiotic use should be weighed against the increased risk of multi-drug resistant nosocomial infections among these patients [28,29] While the current study design does not allow assertions about efficacy, early and proactive use of corticosteroids seemed to improve the disease course regardless of the timing of presentation and severity of illness. We did not encounter a widespread increase in the number of opportunistic infections.…”