The controversial bond between COVID-19 and bacterial superinfections

Bonazzetti, Cecilia; Giannella, Maddalena

doi:10.1016/j.cmi.2022.12.023

Cited by 1 publication

(2 citation statements)

References 19 publications

(30 reference statements)

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“…In comparison to the French study, our COVID-19 patients had a higher SAPS II (43.5 vs. 38) and were more likely to be ventilated (85% vs. 64%), what could have possibly promoted higher infection rates in our patients. BSI was the second most common HAI in our COVID-19 patients, similar to other studies [ 10 , 23 ]. In fact, our BSI incidence of 9.4% is in line with the 14.9% reported by Buetti et al [ 26 ].…”

Section: Discussionsupporting

confidence: 92%

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Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

Bloch,

Rüfenacht,

Ludwinek

et al. 2023

Antimicrob Resist Infect Control

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Background The coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients. Methods We established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable. Results We included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4–3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant. Conclusions These data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.

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Section: Discussionsupporting

confidence: 92%

“…The 56% of COVID-19 patients experiencing at least one HAI is at the upper limit of what has been described in the literature. In critically ill COVID-19 patients (assessed according to ECDC criteria), numbers range from 26 to 44% [ 21 – 23 ]. Pulmonary infections were the most common HAI in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%