tetano
Editor, Senior Moderator
Acute Crit Care
. 2022 Aug;37(3):312-321.
doi: 10.4266/acc.2022.00136. Epub 2022 Aug 29.
Risk factors associated with development of coinfection in critically Ill patients with COVID-19
Erica M Orsini[SUP] 1 [/SUP], Gretchen L Sacha[SUP] 2 [/SUP], Xiaozhen Han[SUP] 3 [/SUP], Xiaofeng Wang[SUP] 3 [/SUP], Abhijit Duggal[SUP] 1 [/SUP], Prabalini Rajendram[SUP] 4 [/SUP]
Affiliations
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.
Keywords: COVID-19; antibiotic stewardship; coinfection; drug resistance; microbial.
. 2022 Aug;37(3):312-321.
doi: 10.4266/acc.2022.00136. Epub 2022 Aug 29.
Risk factors associated with development of coinfection in critically Ill patients with COVID-19
Erica M Orsini[SUP] 1 [/SUP], Gretchen L Sacha[SUP] 2 [/SUP], Xiaozhen Han[SUP] 3 [/SUP], Xiaofeng Wang[SUP] 3 [/SUP], Abhijit Duggal[SUP] 1 [/SUP], Prabalini Rajendram[SUP] 4 [/SUP]
Affiliations
- PMID: 36102003
- DOI: 10.4266/acc.2022.00136
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.
Keywords: COVID-19; antibiotic stewardship; coinfection; drug resistance; microbial.