Secondary Bacterial Infection and Clinical Characteristics in Patients With COVID-19 Admitted to Two Intensive Care Units of an Academic Hospital in Iran During the First Wave of the Pandemic

Pourajam, Samaneh; Kalantari, Elham; Talebzadeh, Hamid; Mellali, Hamid; Sami, Ramin; Soltaninejad, Forogh; Amra, Babak; Sajadi, Mahdi; Alenaseri, Malihe; Kalantari, Forough; Solgi, Hamid

doi:10.3389/fcimb.2022.784130

Cited by 51 publications

(72 citation statements)

References 22 publications

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“…In line with previous studies, 6 , 8 , 13 , 16 , 18 a higher mortality was observed in patients who suffered from secondary infection. A significant association was found between secondary bacterial infection and mortality, of which 65.7% deaths were reported.…”

Section: Discussionsupporting

confidence: 92%

“…Similarly, several studies observed an increased occurrence of gram-negative organisms as opposed to gram-positive. 6 , 14 , 16–18 In line with Musuuza et al, 6 the most prevalent pathogens in the current study were P. aeruginosa and A. baumannii . Secondary infection of the respiratory system was the most common followed by bloodstream infection.…”

Section: Discussionsupporting

confidence: 87%

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Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Alshrefy¹,

Alwohaibi²,

Alhazzaa³

et al. 2022

IJGM

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Purpose Secondary infections have been observed among coronavirus disease 2019 (COVID-19) patients, especially in the intensive care unit (ICU) setting, which is associated with worse clinical outcomes. The current study aimed to investigate the incidence, common pathogens, and outcome of bacterial and fungal secondary infections among ICU patients with COVID-19. Methods A retrospective chart review of all patients admitted to the ICU at King Fahd Hospital of the University in Saudi Arabia. All adult patients aged ≥18 admitted in the ICU for ≥48 hours with positive COVID-19 reverse transcription-polymerase chain reaction test during the period between March 2020 till September 2021 were included. Results Out of 314 critically ill patients, 133 (42.4%) developed secondary infections. The incidence of secondary bacterial infection was 32.5% with Pseudomonas aeruginosa (n = 34), Acinetobacter baumannii (n = 33), and Klebsiella pneumoniae (n = 17) being the predominant pathogens, while secondary fungal infection was 25.2% mainly caused by Candida albicans (n = 43). Invasive mechanical ventilation was significantly associated with the development of secondary bacterial infections (odds ratio [OR] = 17.702, 95% confidence interval [CI] 7.842–39.961, p < 0.001) and secondary fungal infections (OR = 12.914, 95% CI 5.406–30.849, p < 0.001). Mortality among patients with secondary infections was 69.2% (n = 92). Secondary infections were associated with longer hospital and ICU stays with a median of 25 days (interquartile range [IQR] 17–42) and 19 days (IQR 13–32), respectively. Conclusion Bacterial and fungal secondary infections are common among COVID-19 patients admitted to the ICU with a predominance of gram-negative bacteria and Candida species. The development of secondary infections was significantly associated with invasive mechanical ventilation. Poor clinical outcomes have been observed, demonstrated with a prolonged hospital and ICU stays and higher mortality.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Alshrefy¹,

Alwohaibi²,

Alhazzaa³

et al. 2022

IJGM

View full text Add to dashboard Cite

show abstract

“…Several complications can arise during ICU stay, from both COVID-19 extensive lung damage and extra-pulmonary involvement, as well as those secondary to mechanical supporting systems [ 2 , 3 , 4 , 5 , 6 ]. Among these, bacterial and fungal co-infections and superinfections (or secondary infections) play an important role in COVID-19 disease and have been associated with increased morbidity and mortality, especially in critically ill patients [ 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background: Bacterial and fungal co-infections and superinfections have a critical role in the outcome of the COVID-19 patients admitted to the Intensive Care Unit (ICU). Methods: The present study is a retrospective analysis of 95 patients admitted to the ICU for COVID-19-related ARDS during the first (February–May 2020) and second waves of the pandemic (October 2020–January 2021). Demographic and clinical data, CT imaging features, and pulmonary and extra-pulmonary complications were recorded, as well as the temporal evolution of CT findings when more than one scan was available. The presence of co-infections and superinfections was registered, reporting the culprit pathogens and the specimen type for culture. A comparison between patients with and without bacterial and/or co-infections/superinfections was performed. Results: Sixty-three patients (66.3%) developed at least one confirmed co-infection/superinfection, with 52 (82.5%) developing pneumonia and 43 (68.3%) bloodstream infection. Gram-negative bacteria were the most common co-pathogens identified and Aspergillus spp. was the most frequent pulmonary microorganism. Consolidations, cavitations, and bronchiectasis were significantly associated with the presence of co-infections/superinfections (p = 0.009, p = 0.010 and p = 0.009, respectively); when considering only patients with pulmonary co-pathogens, only consolidations remained statistically significative (p = 0.004). Invasive pulmonary aspergillosis was significantly associated with the presence of cavitations and bronchiectasis (p < 0.001). Patients with co-infections/superinfections presented a significantly higher mortality rate compared to patients with COVID-19 only (52.4% vs. 25%, p = 0.016). Conclusions: Bacterial and fungal co-infections and superinfections are frequent in COVID-19 patients admitted to ICU and are associated with worse outcomes. Imaging plays an important role in monitoring critically ill COVID-19 patients and may help detect these complications, suggesting further laboratory investigations.

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Section: Methodsmentioning

confidence: 99%

“…For the secondary infections Secondary infections were identified by infection that developed during ICU stay but after admission of more than 48 h duration, meaning not present at the time of presentation with COVID-19. 13 Exclusion criteria: Patients tested negative/inconclusive for SARS-COV-2 infection and those patients tested positive for SARS-COV-2, but not hospitalized.…”

Section: Study Populationmentioning

confidence: 99%

Profile of Secondary Bacterial and Fungal Infections in Hospitalized COVID-19 Patients in a Tertiary Care Centre

K¹,

Madi²,

Bhat³

et al. 2022

IDR

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Introduction: SARS CoV-2, a novel corona virus, has emerged in December 2019. The COVID-19 associated mortality is documented in elderly with co morbidities. To have better insight on this issue, the secondary bacterial infections with multi-drugresistant bacteria in COVID-19 patients need to be studied to evaluate the impact of these infections on the outcome. Aim and objectives: To determine the proportion of secondary infections in COVID-19 patients. To study the spectrum of pathogens and antibiogram of the bacteria isolated from secondary infections in such patients. To evaluate the co-existing co-morbidities, treatment and outcome in these patients. Methodology: The retrospective study was conducted in Departments of Medicine and Microbiology, KMC hospitals Attavara and Ambedkar circle, Mangaluru, including all the hospitalized microbiologically confirmed cases of SARS CoV-2 infection. Details pertaining to the study population were collected using a structured proforma. Descriptive data were entered in the form of mean, median and proportions. The categorical values were analyzed using Chi square test. Values of p < 0.05 were considered as statistically significant.Results: Two hundred COVID-19 hospitalized patients were included.28 out of 200 patients (14%) studied developed secondary infections. The types of secondary infections were Respiratory infections (50%), blood stream infections (17%), UTI (14%), Rhinocerebral Zygomycosis (17%). The predominant organisms were Klebsiella pneumoniae (44%), Zygomycetes (17%). The rates of antibiotic resistance in Gram negative bacilli were 33% to Cefuroxime,25% to aminoglycosides and fluoroquinolones and 16% to carbapenems. The mortality of 42.8% was observed in patients with secondary infections. Conclusion: Close monitoring and follow up especially in high-risk group of severe COVID 19 patients is crucial for better management and outcome.

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Secondary Bacterial Infection and Clinical Characteristics in Patients With COVID-19 Admitted to Two Intensive Care Units of an Academic Hospital in Iran During the First Wave of the Pandemic

Cited by 51 publications

References 22 publications

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU

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

Profile of Secondary Bacterial and Fungal Infections in Hospitalized COVID-19 Patients in a Tertiary Care Centre

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