Secondary infection in COVID-19 critically ill patients: a retrospective single-center evaluation

Abstract

Background Patients infected with severe acute respiratory syndrome coronavirus (SARS-CoV-2) can develop severe illness necessitating intensive care admission. Critically ill patients are susceptible for the development of secondary bacterial infections. Due to a combination of virus- and drug-induced immunosuppression, critically ill patients with corona virus disease 2019 (COVID-19) may even have a higher risk of developing a secondary infection. These secondary infections can aggravate the severity of illness and increase the risk of death. Further research on secondary infections in COVID-19 patients is essential. Therefore, the objective of this study was to investigate the incidence and associated risk factors of secondary bacterial infections and to identify the most common groups of pathogens in critically ill COVID-19 patients. Methods This mono-center, retrospective observational cohort study was performed at the intensive care unit (ICU) of the Jessa Hospital, Hasselt, Belgium. All adult COVID-19 patients admitted to the ICU from 13th March 2020 until 17th October 2020, were eligible for inclusion in the study. Data from the resulting 116 patients were prospectively entered into a customized database. The resulting database was retrospectively reviewed to investigate three types of secondary bacterial infections (secondary pneumonia, bloodstream infections of unknown origin, catheter-related sepsis). Results Of 94 included patients, 68% acquired at least one of the studied secondary bacterial infections during their ICU stay. Almost two thirds of patients (65.96%, n = 62) acquired a secondary pneumonia, whereas 29.79% (n = 28) acquired a bacteremia of unknown origin and a smaller proportion of patients (14.89%, n = 14) acquired a catheter-related sepsis. Male gender (P = 0.05), diabetes mellitus (P = 0.03) and the cumulative dose of corticosteroids (P = 0.004) were associated with increased risk of secondary bacterial infection. The most common pathogens detected in the cultures of patients with secondary pneumonia were Gram-negative bacilli. Bacteremia of unknown origin and catheter-related sepsis were mostly caused by Gram-positive cocci. Conclusion This study confirms that the incidence of secondary bacterial infections is very high in critically ill COVID-19 patients. These patients are at highest risk of developing secondary pneumonia. Male gender, a history of diabetes mellitus and the administration of corticosteroids were associated with increased risk of secondary bacterial infection.

In Silico transcriptional analysis of asymptomatic and severe COVID-19 patients reveals the susceptibility of severe patients to other comorbidities and non-viral pathological conditions

“…Interestingly, we also observed that COVID-19 severe patients might have an increased risk of bacterial, fungal infection compared to asymptomatic patients. This observation of reduced viral infection but increased secondary infection aligns with previous studies on COVID-19 patients [129, 130]. The immune response involved in viral and bacterial infection shares different immune components [131–136].…”

Differential Immune Checkpoint and Ig-like V-Type Receptor Profiles in COVID-19: Associations with Severity and Treatment

“…Beyond severity due to oxygen requirement during hospitalization, the appearance of secondary infections remains a major issue in the management of COVID-19 patients [ 3 , 4 , 8 , 31 ]. We compared the baseline parameters, classifying patients according to whether they developed secondary infections during their stay.…”

“…Herein, we have described a high-dimensional comprehensive study of the baseline clinical and immunological differences in COVID-19 patients during the first wave of the pandemic in Madrid, Spain. We have defined potential early markers (upon arrival at ED) associated with both hospital requirement and one of the biggest complications in these patients, secondary infections [ 3 , 4 , 8 ]. In addition, thanks to the collection of longitudinal samples during the patients’ stays, we have sought to describe the immunological changes that occur due to secondary infection as well as after treatment with one of the most used drugs, corticosteroids.…”

“…The only treatment that showed an improvement in patients’ survival during the first waves of the pandemic was the use of corticosteroids [ 1 , 2 ]. Nonetheless, critically ill and drug-immunosuppressed patients are highly susceptible to develop secondary bacterial infections such as secondary pneumonia, bloodstream infections and catheter-related sepsis, all of which strongly impact the final outcome [ 3 , 4 , 5 , 6 , 7 , 8 ]. These data highlight the need for continued study of the immune response in this pathology.…”

Microbial diversity and antimicrobial susceptibility in endotracheal tube biofilms recovered from mechanically ventilated COVID-19 patients

“…Since the start of the COVID-19 pandemic, respiratory coinfections have been reported in a large number of studies, and in the first small-scale studies during the initial outbreak in Wuhan (China), coinfections were reported in up to 50% of patients investigated [ 1 ]. There is however substantial variability in the reported prevalence of coinfections with some studies showing rates from 30% to 90% [ [2] , [3] , [4] , [5] ], whereas others report far lower rates [ [6] , [7] , [8] , [9] ]. Studies involving large patient cohorts show a percentage of clinically significant bacterial infections in hospitalized patients of around 4–14%, with the highest incidence being reported in patients on intensive care units (ICU) [ [10] , [11] , [12] ].…”