Risk factors associated with development of coinfection in critically Ill patients with COVID-19

Abstract

Background: At outset of the coronavirus disease 2019 (COVID-19) pandemic, the significance of bacterial and fungal coinfections in individuals with COVID-19 was unknown. Initial reports indicated that the prevalence of coinfection in the general population was low, but there was uncertainty regarding the risk of coinfection in critically ill patients.Methods: Nine hundred critically ill adult patients with COVID-19 infection were enrolled in this observational case-control study. Patients with a coinfection (case) and patients without a coinfection (control) were compared using univariate and multivariable analyses. A subgroup analysis was performed on patients with coinfection, dividing them into early (infection within 7 days) and late (infection after 7 days) infection groups.Results: Two hundred and thirty-three patients (25.9%) had a bacterial or fungal coinfection. Vasopressor use (P<0.001) and severity of illness (higher Acute Physiology and Chronic Health Evaluation III score, P=0.009) were risk factors for the development of a coinfection. Patients with coinfection had higher mortality and length of stay. Vasopressor and corticosteroid use and central line and foley catheter placement were risk factors for late infection (>7 days). There were high rates of drug-resistant infections.Conclusions: Critically ill patients with COVID-19 are at risk for both community-acquired and hospital-acquired infections throughout their hospitalization for COVID-19. It is important to consider the development of a coinfection in clinically worsening critically ill patients with COVID-19 and consider the likelihood of drug-resistance when choosing an empiric regimen.

Prevalence and risk factors associated with multidrug-resistant bacteria in COVID-19 patients

“…Secondly, a significant factor is the possibility of nosocomial coinfections in critically ill patients during COVID-19 related which results in prolonged hospitalization. [21] To preclude this situation, targeted plans to improve the long-term infection control measures within the relevant facilities are essential. Another finding that may require scientific interpretation is that the high prevalence of males (77.7%) in recruited patients compared to females.…”

Prevalence of secondary infections and association with mortality rates of hospitalized COVID-19 patients

“… 15 , 16 Hospital-acquired superinfections were reported more than co-infections in multiple other articles. 9 , 12 , 14 , 15 , 17 …”

“…Our results are in line with multiple studies, which showed that the length of hospital stay increased exponentially both locally (16.2 vs. 35.2 days), and internationally where the duration of ICU stay was 6.7 vs. 13.8 days, and hospital stay was 11.8 vs. 18.6 days. 9 , 17 …”

“… 13 A case control study conducted at Northeastern Ohio and Florida showed that 83.2% of critically ill COVID-19 patients received antibiotics, and that a higher rate of corticosteroids and tocilizumab were administered to patients with co-infections compared to patients without co-infections, 66.1% vs. 56.8% ( P =.013) and 22.7% vs. 13.2% ( P =.001), respectively. 17 An updated literature review notes that rather than evidence-based estimation of the risk of co-infection or superinfection, the present practice of empirical antibiotic use in COVID-19 appears to be based on the risk of co-infection with influenza virus. However, empirical antimicrobial agents have been useful in high-risk patients such as severely ill and immunocompromised.…”

“…This is in line with an international study, reporting a higher proportion of invasive procedures for co-infected ICU patients only. 17 …”