Risk factors and effect on mortality of superinfections in a newly established COVID-19 respiratory sub-intensive care unit at University Hospital in Rome

Abstract

Background Little is known on the burden of co-infections and superinfections in a specific setting such as the respiratory COVID-19 sub-intensive care unit. This study aims to (i) assess the prevalence of concurrent and superinfections in a respiratory sub-intensive care unit, (ii) evaluate the risk factors for superinfections development and (iii) assess the impact of superinfections on in-hospital mortality. Methods Single-center retrospective analysis of prospectively collected data including COVID-19 patients hospitalized in a newly established respiratory sub-intensive care unit managed by pneumologists which has been set up from September 2020 at a large (1200 beds) University Hospital in Rome. Inclusion criteria were: (i) COVID-19 respiratory failure and/or ARDS; (ii) hospitalization in respiratory sub-intensive care unit and (iii) age > 18 years. Survival was analyzed by Kaplan–Meier curves and the statistical significance of the differences between the two groups was assessed using the log-rank test. Multivariable logistic regression and Cox regression model were performed to tease out the independent predictors for superinfections’ development and for mortality, respectively. Results A total of 201 patients were included. The majority (106, 52%) presented severe COVID-19. Co-infections were 4 (1.9%), whereas 46 patients (22%) developed superinfections, mostly primary bloodstream infections and pneumonia. In 40.6% of cases, multi-drug resistant pathogens were detected, with carbapenem-resistant Acinetobacter baumannii (CR-Ab) isolated in 47%. Overall mortality rate was 30%. Prior (30-d) infection and exposure to antibiotic therapy were independent risk factors for superinfection development whereas the development of superinfections was an independent risk factors for in-hospital mortality. CR-Ab resulted independently associated with 14-d mortality. Conclusion In a COVID-19 respiratory sub-intensive care unit, superinfections were common and represented an independent predictor of mortality. CR-Ab infections occurred in almost half of patients and were associated with high mortality. Infection control rules and antimicrobial stewardship are crucial in this specific setting to limit the spread of multi-drug resistant organisms.

Secondary pulmonary infection and co-infection in elderly COVID-19 patients during the pandemics in a tertiary general hospital in Beijing, China

“…The results of antimicrobial susceptibility testing showed that most of A. baumannii and K. pneumoniae were resistant to carbapenems, the patients infected with CR-GNB had a considerably high mortality. Previous study showed in a COVID-19 respiratory sub-intensive care unit, carbapenem-resistant A. baumannii (CRAB) infections occurred in almost half of patients and were associated with high mortality ( Iacovelli et al, 2023 ). Thus, these findings suggested that infection control measures should be enhanced to prevent the transmission of CR-GNB in healthcare settings among older patients.…”

Antibiotic-Resistant ESKAPE Pathogens and COVID-19: The Pandemic beyond the Pandemic

“…Commonly identified co-pathogens of SARS-CoV-2 were Streptococcus pneumoniae , S. aureus , K. pneumoniae , Haemophilus influenzae , Mycoplasma pneumoniae , A. baumannii , Legionella pneumophila , and Clamydia pneumoniae , followed by coronavirus, rhinovirus/enterovirus, parainfluenza, metapneumovirus, influenza B virus, and human immunodeficiency virus [ 154 ]. Among bacteria, once again, K. pneumoniae and A. baumannii were recognized as the most common pathogens [ 71 , 155 , 156 , 157 ] and often co-isolated from polymicrobial infections. The co-infections can be more severe and obstinate to therapy than infections caused by either species alone.…”

Inhalation phage therapy as a new approach to preventing secondary bacterial pneumonia in patients with moderate to severe COVID-19: A double-blind clinical trial study

“…Infection stimulates immunity and hence exacerbates respiratory issues such as micro thrombosis in lung vessels. Secondary bacterial infection has also been reported to cause high mortality in patients with COVID-19 [ 5 , 6 ]. Recently, 50% of mortality was reported in patients with COVID-19 secondary bacterial infection [ 5 ].…”

“…Recently, 50% of mortality was reported in patients with COVID-19 secondary bacterial infection [ 5 ]. Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumonia, and Acinetobacter baumannii are common causes of secondary nosocomial infections in these patients [ [5] , [6] , [7] ]. At present, these bacteria have become resistant to many antibiotics.…”

“…Due to the emergence and spread of antibiotic resistance, increasing treatment costs and mortality of patients with respiratory infections require a suitable option for prevention and treatment. Empirical treatment of lung infections with various antibiotics has resulted in resistant strains of vancomycin-resistant Staphylococcus aureus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA), and gram-negative extended β-lactamase [ 5 , 6 ].…”