Risk factors associated with bloodstream infections among critically ill patients with COVID-19

McMillan, Tim; Jones, Conor S; O'Connor, Cavan; Nolan, Daniel; Chan, Xin Hui S; Ellis, Jayne; Thakker, Clare; Kranzer, Katharina; Stone, Neil; Singer, Mervyn; Wilson, A Peter R; Arulkumaran, Nishkantha

doi:10.1016/j.jinf.2021.09.010

Cited by 3 publications

(8 citation statements)

References 10 publications

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“…These results show that the decision to treat COVID-19 patients with dexamethasone should always be a matter of careful consideration as it also involves risks. This dichotomy is confirmed by other studies that showed an association between corticoid therapy and an increased incidence of bacteremia [ 15 , 18 , 19 , 20 ]. Rothe et al described a significant increase in polymicrobial detection, an association with respiratory infection complications, and a higher mortality rate in the group of invasively ventilated patients treated with dexamethasone (49.6% of invasively ventilated patients without dexamethasone vs. 55.9% of invasively ventilated patients with dexamethasone) [ 18 ].…”

Section: Discussionsupporting

confidence: 77%

Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients

Kodde

Timmen

Hohenstein

et al. 2023

Viruses

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Background: Even though several therapeutic options are available, COVID-19 is still lacking a specific treatment regimen. One potential option is dexamethasone, which has been established since the early beginnings of the pandemic. The aim of this study was to determine its effects on the microbiological findings in critically ill COVID-19 patients. Methods: A multi-center, retrospective study was conducted, in which all the adult patients who had a laboratory-confirmed (PCR) SARS-CoV-2 infection and were treated on intensive care units in one of twenty hospitals of the German Helios network between February 2020–March 2021 were included. Two cohorts were formed: patients who received dexamethasone and those who did not, followed by two subgroups according to the application of oxygen: invasive vs. non-invasive. Results: The study population consisted of 1.776 patients, 1070 of whom received dexamethasone, and 517 (48.3%) patients with dexamethasone were mechanically ventilated, compared to 350 (49.6%) without dexamethasone. Ventilated patients with dexamethasone were more likely to have any pathogen detection than those without (p < 0.026; OR = 1.41; 95% CI 1.04–1.91). A significantly higher risk for the respiratory detection of Klebsiella spp. (p = 0.016; OR = 1.68 95% CI 1.10–2.57) and for Enterobacterales (p = 0.008; OR = 1.57; 95% CI 1.12–2.19) was found for the dexamethasone cohort. Invasive ventilation was an independent risk factor for in-hospital mortality (p < 0.01; OR = 6.39; 95% CI 4.71–8.66). This risk increased significantly in patients aged 80 years or older by 3.3-fold (p < 0.01; OR = 3.3; 95% CI 2.02–5.37) when receiving dexamethasone. Conclusion: Our results show that the decision to treat COVID-19 patients with dexamethasone should be a matter of careful consideration as it involves risks and bacterial shifts.

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Section: Discussionsupporting

confidence: 77%

Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients

Kodde

Timmen

Hohenstein

et al. 2023

Viruses

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“…Steroids were widely used in both waves, but tocilizumab was introduced during the second [ 6 ]. While tocilizumab and earlier use of steroids are immunosuppressive, they may promote more rapid recovery and reduced need for mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

“…The absence of individual patient-level data on comorbidities and other treatments including mechanical ventilation in our cohort limits interpretation. However, there was no significant difference in the length of ICU stay between the two waves and neither dexamethasone nor tocilizumab appeared to increase the risk of bacteraemia in this cohort of patients [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Co-infections were defined as those diagnosed within two days of admission to ICU, while later infections were considered secondary. The effects of therapy for COVID-19 on bacteraemia and need for treatment have been reported separately [ 6 ]…”

Section: Methodsmentioning

confidence: 99%

“…The key differences in hospital management between these two waves resulted partly from experience gained with treating this new disease and from an increased use of immunosuppressive agents, particularly dexamethasone and tocilizumab, following the findings of the RECOVERY trials [ 3 , 4 ]. If use of such agents were associated with an increase in secondary infections, there would be further challenges for diagnosis and antimicrobial stewardship [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reducing broad-spectrum antibiotic use in intensive care unit between first and second waves of COVID-19 did not adversely affect mortality

Chan

O'Connor

Martyn

et al. 2022

Journal of Hospital Infection

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Impact of intensified prevention measures on the rate of hospital-acquired bloodstream infections among mechanically ventilated COVID-19 patients

Lampl,

Cohen,

Maor

et al. 2023

ASHE

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Background: The COVID-19 pandemic was associated with increased rates of hospital-acquired infections. During the early months of the pandemic, we observed high rates of hospital-acquired bloodstream infections (HA-BSIs) among COVID-19 patients, prompting the implementation of intensified prevention measures. Objectives: To assess the prevalence of HA-BSI among mechanically ventilated COVID-19 patients, identify risk factors, and evaluate the effect of prevention measures. Methods: We conducted a retrospective matched case-control study in adult medical step-up units between March 1, 2020, and March 31, 2021. We matched mechanically ventilated COVID-19 patients with ventilated non-COVID-19 patients based on age group and length of stay before ventilation. In response to the high rates of HA-BSI among COVID-19 patients, a comprehensive infection control intervention was implemented. Results: A total of 136 COVID-19 patients were matched with 136 non-COVID-19 patients. No significant differences were observed in pre-hospitalization characteristics. The central venous catheter utilization ratio was higher in COVID-19 patients (83.6%) versus 35.6% in the control group (p < 0.001). During pre-intervention, 35.2% (32/91) of COVID-19 patients developed HA-BSI, compared to 17.8% (13/73) in the control group (p < 0.001). Following the intervention, no significant difference was observed between the groups (17.8% (8/45) versus 15.9% (10 /63), p = 0.79). In a multivariate analysis, HA-BSI was associated with low body mass index (OR 0.9 (95% CI 0.9–1.0), p = 0.015)) and presence of temporary dialysis catheter (OR 2.7 (95% CI 1.0–7.3), p = 0.05)). Conclusions: Mechanically ventilated COVID-19 patients were at higher risk for developing HA-BSI compared to non-COVID-19 patients. Intensified prevention measures were associated with decreased rates of HA-BSI.

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Risk factors associated with bloodstream infections among critically ill patients with COVID-19

Cited by 3 publications

References 10 publications

Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients

Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients

Reducing broad-spectrum antibiotic use in intensive care unit between first and second waves of COVID-19 did not adversely affect mortality

Impact of intensified prevention measures on the rate of hospital-acquired bloodstream infections among mechanically ventilated COVID-19 patients

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