Background A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired secondary bacterial infections (SBIs). The etiology and antimicrobial resistance of bacteria were reported and used to provide a theoretical basis for appropriate infection therapy. Methods This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 27 and March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. Results Among 1495 patients hospitalized with COVID-19, 102 (6.8%) patients had acquired SBIs, and almost half of them (49.0%, 50/102) died during hospitalization. Compared with severe patients, critical patients had a higher chance of SBIs. Among the 159 strains of bacteria isolated from the SBIs, 136 strains (85.5%) were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%, 57/159), K. pneumoniae (30.8%, 49/159), and S. maltophilia (6.3%, 10/159). The isolation rates of carbapenem-resistant A. baumannii and K. pneumoniae were 91.2 and 75.5%, respectively. Meticillin resistance was present in 100% of Staphylococcus aureus and Coagulase negative staphylococci, and vancomycin resistance was not found. Conclusions SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the severity of illness on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. This was a single-center study; thus, our results should be externally examined when applied in other institutions.

Background: A considerable proportion of patients hospitalized with corona virus disease 2019 (COVID-19) have acquired secondary bacterial infections (SBIs). We report the etiology and antimicrobial resistance of bacteria to provide theoretical basis for appropriate infection therapy.Methods: In the retrospective study, we reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union hospital from January 27 to March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe on admission and those who were classified as critical.Results: 6.8% (102/1495) of the patients with COVID-19 had acquired SBIs and almost half of them (50, 49.0%) died during hospitalization. Compared with the severe patients, the critical patients had a higher chance of SBIs. 159 strains of bacteria were isolated, 85.5% of which were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%), K. pneumoniae (30.8%) and Staphylococcus (8.8%). The isolation rate of carbapenem-resistant A. baumannii and K. pneumoniae were 91.2% and 75.5%, respectively. Meticillin resistance was in 100% of Staphylococcus, and vancomycin resistance was not found. Conclusions: SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the grade on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main bacteria and the resistance rates of the major isolated bacteria were generally high.

Background: Severe patients hospitalized with COVID-19 suffered secondary infections which greatly increased the length of hospital stay and the mortality. We aimed to explore risk factors of secondary infections that can help clinicians early implement preventive measures to dispose of severe and critical inpatients with COVID-19.Methods: A case-control study enrolled 238 severe and critical patients with COVID-19. Characteristics of cases and controls were compared.Results: Severity of illness on admission, ICU admission, ventilator, central venous catheterization were common in the cases, however almost none of these factors was observed in the controls. Multivariable regression showed risk factors of secondary infections included male (OR 4.08; 95% CI 1.58-10.50), age 65 or older (OR 3.11; 95% CI 1.25-7.76), heart diseases (OR 3.96; 95% CI 1.40-11.27), hypoproteinemia on admission (OR 6.41; 95% CI 1.65-24.92) and corticosteroids (OR 19.83; 95% CI 7.3-53.55) and proton-pump inhibitors (OR 3.96; 95% CI 1.51-10.37).Conclusions: male, older age, heart diseases, hypoproteinemia, corticosteroid and proton-pump inhibitors were independent risk factors of secondary infections. Inpatients needing ICU admission and invasive devices still need to be given optimal cares and to be minimized the duration.

Background Secondary bloodstream infection (SBI) is considered one of the most perilous complications of coronavirus disease 2019 (COVID-19). Although the etiology of SBI has been reported, the clinical course and outcomes of this illness have not been well described. Methods In this retrospective study, all patients with confirmed SBI were included from a cohort of 1,651 patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 25 and April 23, 2020. Demographics, clinical features, laboratory findings, treatments and outcomes were extracted from electronic medical records. The data were compared between survivors and non-survivors based on whether patients died within 30 days following SBI onset. Results A total of 31 patients corresponding to 1.9% (31/1,651) who exhibited SBI were included in the present study. The median time from admission to the onset of SBI was 22.0 days (2.0–64.0). The most common symptoms were shortness of breath (74%), fever (65%) and decreased blood pressure (52%) at the onset of SBI. The levels of white blood cell count, C-reactive protein, and procalcitonin were mostly elevated. Carbapenem-resistant Klebsiella pneumoniae (15 [48%]) and Acinetobacter baumannii (7 [23%]) were the main pathogens. In empirical treatment, carbapenems were still the first choice. The 30-day mortality following SBI onset and the hospital mortality of the 31 patients were 67.7% (21/31) and 77.4% (24/31), respectively. Almost every patient with SBI had complication due to sepsis (28 [90%]). The median time periods to sepsis and septic shock were 1 days (1.0 ~ 5.0) and 3.0 days (1.0 ~ 12.0), respectively. The proportion of carbapenem-resistant gram-negative bacteria (CRGNB) detected in blood cultures of non-survivors was higher (18 [86%] vs. 4 [40%]) compared to that of the survivors. These patients were more likely to develop sepsis (21 [100%] vs. 7 [70%]), and acute cardiac injury (19 [90%] vs. 5 [50%]). Conclusions The mortality of SBI patients with COVID-19 is considerable. Increased risk of mortality was noted for the following three subgroups: Patients infected with CRGNB, patients with complications of sepsis and patients with acute cardiac injury.