Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Abstract

Background Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients. Patients and methods We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching. Results Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05–1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population. Conclusion COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.

Incidence, Risk Factors, and Prognosis of Bloodstream Infections in COVID-19 Patients in Intensive Care: A Single-Center Observational Study

“… 16 Although the data on BSI in COVID-19 patients followed in the ICU were limited at the start of the pandemic, the incidence rate reached 10–47 episodes per 1000 patient-days at risk in more recently published reports. 4 , 5 , 7 These data and the study of Buetti et al demonstrate that the incidence rate of BSI is higher in COVID-19 patients. 6 In our study of 470 patients, 252 BSI episodes developed in 179 patients, and the BSI incidence rate was 50.2 per 1000 patient-days at risk.…”

“…Enterococci and coagulase-negative staphylococci predominated among Gram-positive bacteria. The predominance of a microorganism varies according to series: Gram-negative bacteria in some reports 5 , 7 and Gram-positive bacteria in others. 4 , 17 The distribution of microorganisms in our study was similar to that in the study of Palanisamy et al, who reported A. baumannii and K. pneumoniae as the most commonly isolated organisms.…”

“… 4 , 7 , 8 Although the prevalence differs according to series, the most commonly isolated pathogens are Enterobacteriaceae (including multi-drug resistant Klebsiella pneumoniae ), Pseudomonas aeruginosa , Acinetobacter baumannii , staphylococci, and enterococci. 4 , 5 , 7 , 8 Furthermore, BSIs were found to be associated with higher mortality. 7 The aim of this study was to evaluate the incidence, risk factors, and prognosis of BSI developing in COVID-19 patients who were followed-up in the ICU.…”

Herpesviridae lung reactivation and infection in patients with severe COVID-19 or influenza virus pneumonia: a comparative study

“…Bloodstream infection (BSI) was defined as a bacterial infection identified on blood cultures. If coagulase-negative Staphylococcus were identified, it was considered as a BSI only if 2 sets of blood cultures grew with the same pathogen exhibiting the same resistance profile [ 21 ].…”

Correction to: Characteristics and prognosis of bloodstream infection in patients with COVID‑19 admitted in the ICU: an ancillary study of the COVID‑ICU study

“…Unfortunately, in the original publication of the article [ 1 ], heading of third column in Table 4, was mistakenly mentioned as “ n = 537” instead of “Patients without BSI n = 537”. The corrected Table 4 is given in this erratum.…”