Bacterial and Fungal Superinfections in COVID-19 Patients Hospitalized in an Intensive Care Unit from Timișoara, Romania

Abstract

Purpose Critically ill patients hospitalized in the intensive care unit (ICU) have an increased infection risk. The aim of this study was to determine the bacterial and fungal superinfections rate in Coronavirus disease 2019 (COVID-19) patients stationed in the ICU, identify risk factors associated with their development and to determine whether superinfection plays a role in patients’ outcome in this population. Patients and Methods In this retrospective, non-interventional, single centre, cohort study, medical records of 302 consecutive patients with SARS-COV-2 pneumonia admitted into the COVID-19 ICU of the largest university hospital from Western Romania between October 2020 and May 2021, were reviewed, of whom 236 patients met the inclusion criteria. Results One hundred and nineteen patients developed a superinfection ≥48 h after being admitted to the hospital. Superinfection rate in the ICU was 50.42%. Coagulase-negative Staphylococci (CoNS) and Enterococcus spp. were predominantly isolated from blood cultures, while Acinetobacter baumannii, Staphylococcus aureus and Candida spp. from tracheobronchial aspirates. Significant independent risk factors regarding bacterial/fungal superinfection in COVID-19 patients were obtained for the following variables: number of days of central venous catheter (HR = 1.13 [1.07–1.20], p < 0.001) and prior administration of corticosteroids (HR = 2.80 [1.33–5.93], p = 0.007). Four independent predictive risk factors were associated with unfavorable outcome: age (HR = 1.07 [95% CI 1.03–1.12], p = 0.001); Carmeli Score (HR = 6.09 [1.18–31.50], p = 0.031); body mass index (HR = 1.11 [1.02–1.21], p = 0.011) and the presence of a central venous catheter (HR = 6.49 [1.93–21.89], p = 0.003). Conclusion The superinfection rate in COVID-19 patients was high in this study group. Exogenous risk factors were associated with superinfection more than endogenous factors. Only a small percentage of uninfected COVID-19 patients were not prescribed antibiotics during their hospitalization, raising serious concerns regarding the judicious prescribing of antibiotics in viral infections.

Development and validation of machine learning-based models for predicting healthcare-associated bacterial/fungal infections among COVID-19 inpatients: a retrospective cohort study

“…Nonetheless, PCT could be used as a helpful tool to guide antibiotic therapy for COVID-19 (32). In line with the ndings of previous studies (2,12), multivariate logistic analysis indicated that central venous and urinary catheters are associated with increased infection risk. The most common infection source of catheters is intradermal and catheter interface contamination by organisms, which may come from the patient's skin or from healthcare workers' hands.…”

“…The long-term impacts of viral and bacterial/fungal coinfections on antimicrobial resistance are severe public problems (9). It is di cult for clinicians to identify coinfections early because of similar symptoms and signs, thus leading to a high rate of inappropriate prescription (10)(11)(12). Early empiric antibiotic use varied from 27-84% across different hospitals (10).…”

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…In Romania, one of the first authors to observe that the differences between patients with severe and non-severe cases were not statistically significant was Totan et al [56]. Other studies had similar findings [28,32,60].…”

“…Elevated BUN levels may indicate impaired kidney function, which is a common complication of severe COVID-19 disease. Many authors have reported high levels in data from Romania and suggested a link with the severity of the infection, as well as a possible marker for severity [26,[32][33][34]40,62]. Some authors have reported other common renal markers such as creatinine and urea [30,40,59].…”

Comments on: Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS CoV‐2 infection than negative patients and are associated to a worse outcome

“…2 Another study found that the presence of a central venous catheter was a significant risk factor for bacterial or fungal superinfections in COVID-19 patients, as was the number of days the patient remained catheterized. 3 Fifth, the authors should have mentioned whether any patient had intestinal colonization of carbapenem-resistant Enterobacterales (CRE), as a prospective study found that it was a predictor of superinfections in COVID-19 patients, resulting in a significantly prolonged length of hospital stay in CRE-colonized versus noncolonized patients (p < 0.001). 2 Furthermore, the authors should have highlighted whether any patient had received corticosteroid treatment or immunomodulatory drugs, such as tocilizumab.…”