Prevalence of nosocomial infections in Covid-19 patients admitted to the intensive care unit of Imam Khomeini complex hospital in Tehran

Abstract


 Background and Objectives: Nosocomial infections (NIs) are an important cause of mortality and morbidity in intensive care units (ICU). Pneumonia is the most common serious manifestation of infection in Covid-19 patients. The aim of this study was to investigate the prevalence of pneumonia in Covid-19 patients admitted to the ICU.
 Materials and Methods: In this cross-sectional study, 1240 Covid-19 patients admitted for more than 48 h in the ICUs of Imam Khomeini Complex Hospital (IKCH) in Tehran for seven months in 2020 were included in the study with initial di- agnosis of Covid-19 (PCR test and chest imaging). Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, length of ICU and hospital stay, microbial type and antibiotic resistance. In this study, the pattern of antibiotic resistance was determined using the disk difusion method.
 Results: In this study, 289 (23.3%) out of 1320 patients experienced NIs. 221 (76.4%) out of 289 patients had underlying diseases and the most common of which were hypertension, diabetes and heart disease, respectively. 163 patients (56.4%) were RT-PCR COVID-19 positive and 200 patients (69%) died. The majority of patients with NIs (71%) were over 55 years old. The most common type of nosocomial infection (66%) was ventilator-associated pneumonia (VAE). The most common microorganisms that cause pneumonia were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aerugino- sa, respectively.
 Conclusion: Pneumonia infection is high in Covid-19 patients admitted to the ICU, it needs to be planned with the diagnosis and measures related to the control and prevention of this infection.

Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

“…As already reported in the literature [17], bacterial and/or fungal pneumonia represented the most common superimposed infections. In particular, the identification of a high percentage of Gram-negative microorganisms in our population (mostly constituted of Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) is consistent with the previous data reported in the literature [10,16,39,40] and differs from those identified during both seasonal and pandemic influenza (i.e., Streptococcus pneumoniae. and Staphylococcus aureus) [41][42][43][44].…”

“…The present study reported a high rate of critically ill COVID-19 patients who developed at least one co-infection/superinfection during their ICU hospitalization (66.3%), which is high but similar to other reports [11,16,17]. However, based on the data in the literature, the percentage of COVID-19 patients with co-infections or secondary infections may be highly variable, ranging between 14% and 100%, depending on the differences in the inclusion criteria used, the specimen source, and/or population (both ICU and hospitalized COVID-19 patients vs. ICU patients only) [11,34,35].…”

“…In particular, the incidence of secondary pulmonary infections in hospitalized patients was reported to be 16% (4.8–42.8%) and 6.3% (0.9–33.3%) for bacterial and fungal infections, respectively [ 10 ]. In critically ill patients, the incidence of superinfections is much higher, reaching up to 45% of cases [ 15 , 16 , 17 , 18 ], and is constituted mostly of pneumonia (50%) and bloodstream infections (34%) [ 19 ].…”

“…The reported higher frequency of co-pathogen infections in COVID-19 patients admitted to ICU has been associated with various risk factors. In fact, in addition to the diffuse alveolar damage and the COVID-19-induced immunosuppressed state [ 20 ], ICU patients undergo several invasive procedures (such as endotracheal tube and venous catheter placement), are generally weaker due to the more severe form of illness, have more underlying comorbidities, and are treated longer with anti-inflammatory and antibiotic therapies, thus, resulting in extreme vulnerability and greater susceptibility to both bacterial and fungal infections [ 16 , 21 ].…”

“…According to culture results, the most common co-pathogens identified were mainly Gram-negative bacteria, including Klebsiella pneumoniae, Pseudomonas aeruginosa , Haemophilus influenzae , Escherichia Coli, and Acinetobacter baumannii , although Mycoplasma pneumoniae and Staphylococcus aureus have also been frequently observed [ 10 , 14 , 16 , 23 ]. Among the etiologic agents responsible for fungal co-infections and superinfections, Aspergillus spp.…”