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

Abstract

Background Critically ill COVID-19 patients are prone to bloodstream infections (BSIs). Aim To evaluate the incidence, risk factors, and prognosis of BSIs developing in COVID-19 patients in the intensive care unit (ICU). Methods Patients staying at least 48 h in ICU from 22 March 2020 to 25 May 2021 were included. Demographic, clinical, and laboratory data were analyzed. Results The median age of the sample (n = 470) was 66 years (IQR 56.0-76.0), and 64% were male. The three most common comorbidities were hypertension (49.8%), diabetes mellitus (32.8%), and coronary artery disease (25.7%). Further, 252 BSI episodes developed in 179 patients, and the BSI incidence rate was 50.2 (95% CI 44.3-56.7) per 1000 patient-days. The source of BSI is central venous catheter in 42.5% and lower respiratory tract in 38.9% of the episodes. Acinetobacter baumannii (40%) and carbapenem-resistant Klebsiella pneumoniae (21%) were the most common pathogens. CRP levels were lower in patients receiving tocilizumab. Multivariable analysis revealed that continuous renal replacement therapy, extracorporeal membrane oxygenation, and treatment with a combination of methylprednisolone and tocilizumab were independent risk factors for BSI. The estimated cumulative risk of developing first BSI episode was 50% after 6 days and 100% after 25 days. Of the 179 patients, 149 (83.2%) died, and a statistically significant difference ( p < 0.001) was found in the survival distribution in favor of the group without BSI. Conclusion BSI is a common complication in COVID-19 patients followed in the ICU, and it can lead to mortality. Failure in infection control measures, intensive immunosuppressive treatments, and invasive interventions are among the main factors leading to BSIs.

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

“…BSIs represent the second most frequent complication of COVID‐19 patients 43,44 and in our study, we found a rate of 21% for bacteremia and of 5.8% for fungemia.…”

“…The second most frequent fungal superinfections were attributed to C. albicans (10.6%), similar to other studies. 41,42 BSIs represent the second most frequent complication of COVID-19 patients 43,44 and in our study, we found a rate of 21% for bacteremia and of 5.8% for fungemia.…”

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

“…In the present study, bloodstream infections were confirmed as the second most frequent infective complication, with a significant proportion being Gram-negative pathogens [ 21 , 53 , 54 ]. The elevated prevalence of Enterococcus spp.…”

“…The reported higher frequency of co-pathogen infections in COVID-19 patients admitted to ICU has been associated with various risk factors. In fact, in addition to the diffuse alveolar damage and the COVID-19-induced immunosuppressed state [ 20 ], ICU patients undergo several invasive procedures (such as endotracheal tube and venous catheter placement), are generally weaker due to the more severe form of illness, have more underlying comorbidities, and are treated longer with anti-inflammatory and antibiotic therapies, thus, resulting in extreme vulnerability and greater susceptibility to both bacterial and fungal infections [ 16 , 21 ].…”

Necrotizing pneumonia and severe COVID‐19 in an infant with catheter‐related bloodstream infection by methicillin‐sensitive Staphylococcus aureus

“…Both CR‐BSI and necrotizing pneumonia may be caused by MSSA 4,5 and empirical antibiotics might have masked the effect of the causative pathogens. It may therefore be difficult to determine which infection (CR‐BSI or necrotizing pneumonia) was the cause of the positive blood culture, even if we suppose that necrotizing pneumonia represented a secondary localization of bacteremia.…”