Co-Infections and Superinfections in COVID-19 Critically Ill Patients Are Associated with CT Imaging Abnormalities and the Worst Outcomes

Abstract

Background: Bacterial and fungal co-infections and superinfections have a critical role in the outcome of the COVID-19 patients admitted to the Intensive Care Unit (ICU). Methods: The present study is a retrospective analysis of 95 patients admitted to the ICU for COVID-19-related ARDS during the first (February–May 2020) and second waves of the pandemic (October 2020–January 2021). Demographic and clinical data, CT imaging features, and pulmonary and extra-pulmonary complications were recorded, as well as the temporal evolution of CT findings when more than one scan was available. The presence of co-infections and superinfections was registered, reporting the culprit pathogens and the specimen type for culture. A comparison between patients with and without bacterial and/or co-infections/superinfections was performed. Results: Sixty-three patients (66.3%) developed at least one confirmed co-infection/superinfection, with 52 (82.5%) developing pneumonia and 43 (68.3%) bloodstream infection. Gram-negative bacteria were the most common co-pathogens identified and Aspergillus spp. was the most frequent pulmonary microorganism. Consolidations, cavitations, and bronchiectasis were significantly associated with the presence of co-infections/superinfections (p = 0.009, p = 0.010 and p = 0.009, respectively); when considering only patients with pulmonary co-pathogens, only consolidations remained statistically significative (p = 0.004). Invasive pulmonary aspergillosis was significantly associated with the presence of cavitations and bronchiectasis (p < 0.001). Patients with co-infections/superinfections presented a significantly higher mortality rate compared to patients with COVID-19 only (52.4% vs. 25%, p = 0.016). Conclusions: Bacterial and fungal co-infections and superinfections are frequent in COVID-19 patients admitted to ICU and are associated with worse outcomes. Imaging plays an important role in monitoring critically ill COVID-19 patients and may help detect these complications, suggesting further laboratory investigations.

COVID-19: Has the Liver Been Spared?

“…During the early phases of the pandemic, when viral tests were not available or were scarce, imaging provided considerable help in the diagnosis of COVID-19 pneumonia [ 93 ]. At present, following the advancement in diagnostic laboratory techniques, its role has evolved, and now imaging is pivotal to the detection and monitoring of COVID-19 complications, both pulmonary and visceral, the evolution of which may be heterogeneous and unpredictable [ 94 , 95 , 96 ].…”

Pulmonary Aspergillosis in Critically Ill COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

“…Although viral pneumonia has been recognized as the main cause of severity and mortality, COVID-19 has also been linked to other complications such as coagulation disorders, neurological complications, vascular complications, and gastrointestinal and renal disorders [ 3 , 4 ]. Previous studies have shown that critically ill COVID-19 patients are susceptible to other bacterial, viral, and fungal co-infections (within the first 48 h of admission) and secondary infections (≥48 h of admission), including CAPA [ 5 , 6 , 7 , 8 , 9 ]. Damage of the bronchial mucosa and alveolar injury by the virus, in combination with increased pulmonary epithelial and vascular permeability, may create favorable conditions for the invasion of Aspergillus spp.…”

High Incidence of Candidemia in Critically Ill COVID-19 Patients Supported by Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study

“…Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection ranges from asymptomatic to life-threatening conditions; in severe cases, respiratory failure may require support with invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) in intensive care units (ICU) [ 1 ]. Among coronavirus infectious disease 2019 (COVID-19) critically ill patients, superinfections can contribute to a more severe clinical course and longer hospital stay [ 2 ]. Previous studies demonstrated that the incidence of candidemia in severe COVID-19 patients (0.8–14%) is two- to ten-fold higher than in non-COVID-19 patients [ 3 , 4 , 5 ].…”