Clinical outcomes of and risk factors for secondary infection in patients with severe COVID-19: a multicenter cohort study in South Korea

Abstract

SARS-CoV-2 infection was confirmed by reverse-transcriptase polymerase chain reaction assay; an oxygen saturation level of 94% or less on room air or a need for oxygen support was defined as severe .Background/Aims: Secondary infection with influenza virus occurs in critically ill patients and is associated with substantial morbidity and mortality; however, there is limited information about it in patients with severe coronavirus disease 2019 . Thus, we investigated the clinical outcomes of and risk factors for secondary infections in patients with severe COVID-19. Methods: This study included patients with severe COVID-19 who were admitted to seven hospitals in South Korea between February 2020 to February 2021. Multivariate logistic regression analyses were performed to assess factors associated with the risk of secondary infections. Results: Of the 348 included patients, 104 (29.9%) had at least one infection. There was no statistically significant difference in the 28-day mortality (17.3% vs. 12.3%, p = 0.214), but in-hospital mortality was higher (29.8% vs. 15.2%, p = 0.002) in the infected group than in the non-infected group. The risk factors for secondary infection were a high frailty scale (odds ratio [OR], 1.314; 95% confidence interval [CI], 1.123 to 1.538; p = 0.001), steroid use (OR, 3.110; 95% CI, 1.164 to 8.309; p = 0.024), and the application of mechanical ventilation (OR, 4.653; 95% CI, 2.533 to 8.547; p < 0.001). Conclusions: In-hospital mortality was more than doubled in patients with severe COVID-19 and secondary infections. A high frailty scale, the use of steroids and application of mechanical ventilation were risk factors for secondary infection.

A Comparison of the Effects of Dexamethasone and Methylprednisolone, Used on Level-3 Intensive Care COVID-19 Patients, on Mortality: A Multi-Center Retrospective Study

“…They also found the rates of antibiotic use in patients receiving high and low-dose steroid therapy, respectively (94.7% vs. 76.0%). Na et al 39 found the rate of secondary infection in COVID-19 patients to be 70.2% in their study. They found the mortality rate in patients with secondary infection to be 2 times higher.…”

Immunometabolic features of natural killer cells are associated with infection outcomes in critical illness

“…Our results above suggest that the risk of nosocomial infection in CCI is significantly correlated with the expression of CPT1a and NRF1 in NK cells, and the findings suggest that NK cell-specific mitochondrial fatty acid oxidation and biogenesis might be crucial in host immunity against invading pathogens (37)(38)(39). Several recent studies reported increased risk of secondary infection in critical ill patients with COVID-19 infection, and the occurrence of secondary infection remarkably raises the mortality rate of COVID-19-infected critically ill patients (40)(41)(42)(43)(44)(45). On the basis of our findings, we surmised that the severity and outcome of critical COVID-19 infection may be correlated with NK cell-specific metabolic features, in particular mitochondrial biogenesis and Overview of study and the single-cell immunometabolic regulomic profiling (scMEP) process.…”

Targeted next-generation sequencing of pathogens reveals the profile of secondary infections in COVID-19 patients

“…Secondary infections are also a major cause of increased mortality in patients with COVID-19. Notably, a study [9] found that the rate of vasopressor use, glucocorticoid use, continuous renal replacement therapy, mechanical ventilation, and extracorporeal membrane oxygenation during hospitalisation was higher in patients with secondary infections than in those without, and the mortality rate of patients with secondary infections was approximately twice as high as in those without. Ninetyve patients with positive reverse transcription polymerase chain reaction results for SARS-CoV-2 were included in the present study, including 54 with severe COVID-19 and 41 with critical COVID-19.…”

“…This is consistent with the ndings of Gomez-Simmonds et al [26] that the majority of K. pneumoniae strains (16/17) were drug-resistant. A recent multi-centre study [9] found that the most common pathogens associated with secondary lung infections of hospitalised COVID-19 patients included A. baumannii, Klebsiella spp., Streptococcus spp., Haemophilus in uenzae, and P. aeruginosa, and the most common pathogens associated with secondary bloodstream infections were coagulasenegative Staphylococcus and A. baumannii. A study of critical COVID-19 patients by Meawed et al [27] showed that the common bacterial pathogens in ventilator-associated pneumonia included pandrugresistant K. pneumoniae (41.1%) and multidrug-resistant A. baumannii (27.4%).…”