Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance

Abstract

Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and inhospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU-acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 -3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

“…In line with previous studies, 6 , 8 , 13 , 16 , 18 a higher mortality was observed in patients who suffered from secondary infection. A significant association was found between secondary bacterial infection and mortality, of which 65.7% deaths were reported.…”

“…In comparison to the current study, a longer stay was reported by Costa et al with a duration of ICU and hospital stays of 40 and 48 days, respectively. 18 Garcia-Vidal et al, in contrast, reported a shorter stay of 5 and 20 days in the ICU and hospital, respectively. 8 This variation could be attributed to multiple factors including the baseline health of the patients, the severity of their illness, the disparities between healthcare systems during COVID-19 crisis, and differences in mortality across studies.…”

MDR Pathogens Organisms as Risk Factor of Mortality in Secondary Pulmonary Bacterial Infections Among COVID-19 Patients: Observational Studies in Two Referral Hospitals in West Java, Indonesia

“… 40 The increasing spread of MDR strains of nosocomial pathogens, especially A. baumannii , is likely due to the increase in required interventions for COVID-19 patients, antibiotics overuse, and aggravated by the decline in hygiene protocols in hospitals. 21 , 41 …”

“… 50 Previous studies also reported that gram-negative bacteria were associated with longer hospital stay, longer ICU stay, mechanical ventilator use, and higher mortality. 13 , 21 …”

“… 16 , 20 Previous studies in Brazil analyzed bacterial infections in patients with severe COVID, and already reported multi-drug resistance was present in 96% of A. baumannii and 57% of K. pneumoniae that were associated with longer ICU stay, mechanical ventilation use, and higher mortality. 21 Currently, there are limited studies on secondary infections and antimicrobial use in COVID-19 patients in Indonesia. Therefore, this study aimed to determine the pathogens of secondary pulmonary bacterial infection, antibiotic susceptibility, and risk factors for mortality in COVID-19 patients admitted in two referral hospitals in West Java, Indonesia.…”