Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance

Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the re...

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Published in:	Revista do Instituto de Medicina Tropical de São Paulo 2022-01, Vol.64, p.e6-10
Main Authors:	Costa, Rafael Lessa da, Lamas, Cristiane da Cruz, Simvoulidis, Luiz Fernando Nogueira, Espanha, Claudia Adelino, Moreira, Lorena Pinto Monteiro, Bonancim, Renan Alexandre Baptista, Weber, João Victor Lehmkuhl Azeredo, Ramos, Max Rogerio Freitas, Silva, Eduardo Costa de Freitas, Oliveira, Liszt Palmeira de
Format:	Article
Language:	eng ; por
Subjects:	Bacterial infections Coinfection Coronaviruses COVID-19 Cross Infection - epidemiology Gram-Negative Bacteria Gram-Negative Bacterial Infections - epidemiology Humans Intensive Care Units Mortality Original Pandemics Retrospective Studies SARS-CoV-2 TROPICAL MEDICINE Ventilators Vitamin E
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Summary:	Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.
ISSN:	1678-9946 0036-4665 1678-9946