&lt;p&gt;Analysis of the Risk Factors for Nosocomial Bacterial Infection in Patients with COVID-19 in a Tertiary Hospital&lt;/p&gt;

Keping, Cheng; He, Miao; Qin, Shu; Wu, Ming; Cui-fang, Chen; Xue, Yulei

doi:10.2147/rmhp.s277963

Cited by 30 publications

(27 citation statements)

References 32 publications

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“…Reports of rates of VAP amongst ventilated patients with COVID-19 vary, with rates of 40–86% reported [ 38 – 40 ] and our reported rate of 49% is in keeping with reports from other centres. Although some reports, not focussed specifically on VAP, indicate lower rates of 10% [ 8 ], it is unclear how many of the ICU patients in that cohort were ventilated for at least 48 h. The rates of VAP between centres managing COVID-19 are likely to vary depending on the clinical characteristics of the patients managed, differential ICU admissions policies and clinical factors such as use of immunosuppressive therapies.…”

Section: Discussionsupporting

confidence: 90%

Ventilator-associated pneumonia in critically ill patients with COVID-19

et al. 2021

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Background Pandemic COVID-19 caused by the coronavirus SARS-CoV-2 has a high incidence of patients with severe acute respiratory syndrome (SARS). Many of these patients require admission to an intensive care unit (ICU) for invasive ventilation and are at significant risk of developing a secondary, ventilator-associated pneumonia (VAP). Objectives To study the incidence of VAP and bacterial lung microbiome composition of ventilated COVID-19 and non-COVID-19 patients. Methods In this retrospective observational study, we compared the incidence of VAP and secondary infections using a combination of microbial culture and a TaqMan multi-pathogen array. In addition, we determined the lung microbiome composition using 16S RNA analysis in a subset of samples. The study involved 81 COVID-19 and 144 non-COVID-19 patients receiving invasive ventilation in a single University teaching hospital between March 15th 2020 and August 30th 2020. Results COVID-19 patients were significantly more likely to develop VAP than patients without COVID (Cox proportional hazard ratio 2.01 95% CI 1.14–3.54, p = 0.0015) with an incidence density of 28/1000 ventilator days versus 13/1000 for patients without COVID (p = 0.009). Although the distribution of organisms causing VAP was similar between the two groups, and the pulmonary microbiome was similar, we identified 3 cases of invasive aspergillosis amongst the patients with COVID-19 but none in the non-COVID-19 cohort. Herpesvirade activation was also numerically more frequent amongst patients with COVID-19. Conclusion COVID-19 is associated with an increased risk of VAP, which is not fully explained by the prolonged duration of ventilation. The pulmonary dysbiosis caused by COVID-19, and the causative organisms of secondary pneumonia observed are similar to that seen in critically ill patients ventilated for other reasons.

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Section: Discussionsupporting

confidence: 90%

Ventilator-associated pneumonia in critically ill patients with COVID-19

et al. 2021

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“…However, secondary bacterial infections occur in an appreciable number of critically ill, hospitalized patients, since risk factors for nosocomial infections such as prolonged mechanical ventilation are prominent features of severe disease [ 17 , 18 ]. Bacterial pneumonia, especially ventilator-associated pneumonia, is the most common secondary bacterial infection, but patients with severe COVID-19 are also susceptible to urinary tract and bloodstream infections [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

et al. 2021

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Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection. Methods We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated. Results Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%. Conclusion PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

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“…To date, many studies investigating secondary bacterial infections in COVID-19 patients have relied on cohorts that include these heterogeneous populations of patients. 11 Some have included both non-critically and critically ill patients, 20 while others have focused on only critically ill patients but have not distinguished between intubated and non-intubated populations. Several meta-analyses have suggested low rates of secondary bacterial infections when compared to other viral pandemics, which has led to calls for a conservative antibiotic prescription strategy.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome

Risa

Roach

Budak

et al. 2021

J Intensive Care Med

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Background: COVID-19 has a widely variable clinical syndrome that is difficult to distinguish from bacterial sepsis, leading to high rates of antibiotic use. Early studies indicate low rates of secondary bacterial infections (SBIs) but have included heterogeneous patient populations. Here, we catalogue all SBIs and antibiotic prescription practices in a population of mechanically ventilated patients with COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This was a retrospective cohort study of all patients with COVID-19 ARDS requiring mechanical ventilation from 3 Seattle, Washington hospitals in 2020. Data were obtained via electronic and manual review of the electronic medical record. We report the incidence and site of SBIs, mortality, and antibiotics per day using descriptive statistics. Results: We identified 126 patients with COVID-19 induced ARDS during the study period. Of these patients, 61% developed clinical infection confirmed by bacterial culture. Ventilator associated pneumonia was confirmed in 55% of patients, bacteremia in 20%, and urinary tract infection (UTI) in 17%. Staphylococcus aureus was the most commonly isolated bacterial species. A total of 97% of patients received antibiotics during their hospitalization, and patients received nearly one antibiotic per day during their hospital stay. Conclusions: Mechanically ventilated patients with COVID-19 induced ARDS are at high risk for secondary bacterial infections and have extensive antibiotic exposure.

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<p>Analysis of the Risk Factors for Nosocomial Bacterial Infection in Patients with COVID-19 in a Tertiary Hospital</p>

Cited by 30 publications

References 32 publications

Ventilator-associated pneumonia in critically ill patients with COVID-19

Ventilator-associated pneumonia in critically ill patients with COVID-19

C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

Characterization of Secondary Bacterial Infections and Antibiotic Use in Mechanically Ventilated Patients With COVID-19 Induced Acute Respiratory Distress Syndrome

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