Co-infection in critically ill patients with COVID-19: an observational cohort study from England

Abstract

Introduction. During previous viral pandemics, reported co-infection rates and implicated pathogens have varied. In the 1918 influenza pandemic, a large proportion of severe illness and death was complicated by bacterial co-infection, predominantly Streptococcus pneumoniae and Staphylococcus aureus . Gap statement. A better understanding of the incidence of co-infection in patients with COVID-19 infection and the pathogens involved is necessary for effective antimicrobial stewardship. Aim. To describe the incidence and nature of co-infection in critically ill adults with COVID-19 infection in England. Methodology. A retrospective cohort study of adults with COVID-19 admitted to seven intensive care units (ICUs) in England up to 18 May 2020, was performed. Patients with completed ICU stays were included. The proportion and type of organisms were determined at <48 and >48 h following hospital admission, corresponding to community and hospital-acquired co-infections. Results. Of 254 patients studied (median age 59 years (IQR 49–69); 64.6 % male), 139 clinically significant organisms were identified from 83 (32.7 %) patients. Bacterial co-infections/ co-colonisation were identified within 48 h of admission in 14 (5.5 %) patients; the commonest pathogens were Staphylococcus aureus (four patients) and Streptococcus pneumoniae (two patients). The proportion of pathogens detected increased with duration of ICU stay, consisting largely of Gram-negative bacteria, particularly Klebsiella pneumoniae and Escherichia coli . The co-infection/ co-colonisation rate >48 h after admission was 27/1000 person-days (95 % CI 21.3–34.1). Patients with co-infections/ co-colonisation were more likely to die in ICU (crude OR 1.78,95 % CI 1.03–3.08, P=0.04) compared to those without co-infections/ co-colonisation. Conclusion. We found limited evidence for community-acquired bacterial co-infection in hospitalised adults with COVID-19, but a high rate of Gram-negative infection acquired during ICU stay.

Antibiotic Use and Fatal Outcomes among Critically Ill Patients with COVID-19 in Tacna, Peru

“…The incidence of healthcare-associated infections observed in this study was high compared to that reported in other studies, where the proportion of patients with secondary infection ranged between 5% and 30% [8][9][10][11], probably due to the variability of the diagnostic methods used as well as the treatments indicated. However, when these results are compared with those of studies that only evaluated patients hospitalized in the ICU, more similar results are observed, with incidences of in-hospital infections ranging between 40% and 58% [3,[12][13][14].…”

Secondary Bacterial Infection and Clinical Characteristics in Patients With COVID-19 Admitted to Two Intensive Care Units of an Academic Hospital in Iran During the First Wave of the Pandemic

“…The prevalence of bacterial infections in COVID-19 patients admitted to the ICU has been reported in several studies. (Contou et al, 2020;Sharifipour et al, 2020;Baskaran et al, 2021). A recent systematic review and meta-analysis study evaluating co-infections among patients infected with COVID-19 performed by Langford et al reported that the rate of secondary bacterial infection is 14.3% (Langford et al, 2020).…”

COVID-19: Impact on prescribing and antimicrobial resistance

“…These pathogens have been associated mainly with hospital and ventilator-acquired pneumonia, particularly in the ICU cohorts. Among the gram-positive bacteria, coagulase-negative staphylococci as well as Enterococcus faecalis and Enterococcus faecium, following by S. aureus are the most common and mainly caused of BSIs [5][6][7].…”