Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome

Bardi, Tommaso; Pintado, Vicente; Gómez-Rojo, María; Escudero-Sánchez, Rosa; López, Amal Azzam; Díez-Remesal, Yolanda; Castro, Nilda Martínez; Ruíz-Garbajosa, Patricia; Pestaña, David

doi:10.1007/s10096-020-04142-w

Cited by 240 publications

(339 citation statements)

References 34 publications

(14 reference statements)

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“…Sepsis or septic shock are common complications in COVID-19 patients, especially those requiring ICU admission [ 12 , 34 , 35 , 36 ], and might directly result from SARS-CoV-2 infection [ 37 ]. In a risk assessment for death in adult COVID-19 patients from Wuhan (China) hospitals [ 36 ], sepsis preceded development of secondary bacterial infection in 27 (96.4%) of 28 patients who did not survive, whereas septic shock occurred only in patients who did not survive (38/54 (70.4%) versus 0/137 (0.0%); p < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

“…Usually, superinfections are hospital-acquired (or nosocomial) infections caused by bacterial or fungal (e.g., Candida species) pathogens often displaying a multidrug-resistant phenotype (e.g., carbapenemase-producing Enterobacterales) [ 9 ]. Importantly, these infections have the potential to increase mortality among hospitalized patients with COVID-19 [ 10 , 11 , 12 ], probably because the interaction between SARS-CoV-2 and superinfecting (or secondary) microbial organism(s) may increase SARS-CoV-2-induced tissue destruction and/or facilitate systemic dissemination of co-pathogens [ 13 ]. It is thus likely that prescribed antimicrobial drugs in COVID-19 patients, to reduce severe or fatal outcomes of disease including septic shock, are often unsuccessful [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

Posteraro

Angelis

Menchinelli

et al. 2021

JCM

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The aim of this study was to characterize COVID-19 (SARS-CoV-2-infected) patients who develop bloodstream infection (BSI) and to assess risk factors associated with in-hospital mortality. We conducted a retrospective observational study of adult patients admitted for ≥48 h to a large Central Italy hospital for COVID-19 (1 March to 31 May 2020) who had or had not survived at discharge. We included only patients having blood cultures drawn or other inclusion criteria satisfied. Kaplan–Meier survival or Cox regression analyses were performed of 293 COVID-19 patients studied, 46 patients (15.7%) had a hospital-acquired clinically relevant BSI secondary to SARS-CoV-2 infection, accounting for 58 episodes (49 monomicrobial and 9 polymicrobial) in total. Twelve episodes (20.7%) occurred at day 3 of hospital admission. Sixty-nine species were isolated, including Staphylococcus aureus (32.8%), Enterobacterales (20.7%), Enterococcus faecalis (17.2%), Candida (13.8%) and Pseudomonas aeruginosa (10.3%). Of 69 isolates, 27 (39.1%) were multidrug-resistant organisms. Twelve (54.5%) of 22 patients for whom empirical antimicrobial therapy was inappropriate were infected by a multidrug-resistant organism. Of 46 patients, 26 (56.5%) survived and 20 (43.5%) died. Exploring variables for association with in-hospital mortality identified > 75-year age (HR 2.97, 95% CI 1.15–7.68, p = 0.02), septic shock (HR 6.55, 95% CI 2.36–18.23, p < 0.001) and BSI onset ≤ 3 days (HR 4.68, 95% CI 1.40–15.63, p = 0.01) as risk factors independently associated with death. In our hospital, mortality among COVID-19 patients with BSI was high. While continued vigilance against these infections is essential, identification of risk factors for mortality may help to reduce fatal outcomes in patients with COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

Posteraro

Angelis

Menchinelli

et al. 2021

JCM

View full text Add to dashboard Cite

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“…Marked heterogeneity exists with respect to the risk of VAP in patients with coronavirus disease 2019 (COVID- 19), with incidence ranging from 12-87% between published cohort studies [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

“…Given the marked heterogeneity in VAP incidence among patients with COVID-19 [4][5][6][7] , as well as gaps in mechanistic understanding of secondary bacterial pneumonia, we sought to assess the molecular determinants of VAP in the setting of SARS-CoV-2 infection. We employed a systems biology approach involving immunoprofiling the host transcriptional response and simultaneously assessing lung microbiome dynamics, using a combination of bulk and single cell RNA sequencing and extensive clinical phenotyping.…”

Section: Introductionmentioning

confidence: 99%

Impaired immune signaling and changes in the lung microbiome precede secondary bacterial pneumonia in COVID-19

Tsitsiklis¹,

Zha²,

Byrne³

et al. 2021

Preprint

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Secondary bacterial infections, including ventilator-associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections including in patients with coronavirus disease 2019 (COVID-19). Using a combination of tracheal aspirate bulk and single-cell RNA sequencing (scRNA-seq) we assessed lower respiratory tract immune responses and microbiome dynamics in 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill uninfected controls. Two days before VAP onset we observed a transcriptional signature of bacterial infection. Two weeks prior to VAP onset, following intubation, we observed a striking impairment in immune signaling in COVID-19 patients who developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients with VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. These findings suggest that COVID-19 patients who develop VAP have impaired antibacterial immune defense detectable weeks before secondary infection onset.

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“…SARS-CoV-2 infection, like influenza, confers an increased risk of late onset secondary bacterial infection, often manifesting as ventilator-associated pneumonia (VAP) (3). Marked heterogeneity exists with respect to the risk of VAP in patients with coronavirus disease 2019 (COVID- 19), with incidence ranging from 12-87% between published cohort studies (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Impaired immune signaling and changes in the lung microbiome precede secondary bacterial pneumonia in COVID-19

Tsitsiklis

Byrne

et al. 2021

Preprint

View full text Add to dashboard Cite

Secondary bacterial infections, including ventilator associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections. Critically ill patients with coronavirus disease 2019 (COVID-19) face an elevated risk of VAP, although susceptibility varies widely. Because mechanisms underlying VAP predisposition remained unknown, we assessed lower respiratory tract host immune responses and microbiome dynamics in 36 patients, including 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill controls. We employed a combination of tracheal aspirate bulk and single cell RNA sequencing (scRNA-seq). Two days before VAP onset, a lower respiratory transcriptional signature of bacterial infection was observed, characterized by increased expression of neutrophil degranulation, toll-like receptor and cytokine signaling pathways. When assessed at an earlier time point following endotracheal intubation, more than two weeks prior to VAP onset, we observed a striking early impairment in antibacterial innate and adaptive immune signaling that markedly differed from COVID-19 patients who did not develop VAP. scRNA-seq further demonstrated suppressed immune signaling across monocytes/macrophages, neutrophils and T cells. While viral load did not differ at an early post-intubation timepoint, impaired SARS-CoV-2 clearance and persistent interferon signaling characterized the patients who later developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients who developed VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. Together, these findings demonstrate that COVID-19 patients who develop VAP have impaired antibacterial immune defense weeks before secondary infection onset.

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Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome

Cited by 240 publications

References 34 publications

Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

Risk Factors for Mortality in Adult COVID-19 Patients Who Develop Bloodstream Infections Mostly Caused by Antimicrobial-Resistant Organisms: Analysis at a Large Teaching Hospital in Italy

Impaired immune signaling and changes in the lung microbiome precede secondary bacterial pneumonia in COVID-19

Impaired immune signaling and changes in the lung microbiome precede secondary bacterial pneumonia in COVID-19

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