Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome

• DOI: 10.1007/s10096-020-04142-w
• Publication Date: 2021-01-03T15:02:30Z
• Authors: Tommaso Bardi; Vicente Pintado; Maria Gomez-Rojo; Rosa Escudero-San...; Amal Azzam Lopez; Yolanda Diez-Remesal; Nilda Martinez Ca...; Patricia Ruiz-Gar...; David Pestaña
• Keywords: Male; 0301 basic medicine; Critical Illness; 03 medical and health sciences; Nosocomial infection; Risk Factors; Humans; Hospital Mortality; Outcome; Aged; Retrospective Studies; Cross Infection; Bacteria; SARS-CoV-2; Fungi; COVID-19; Length of Stay; Middle Aged; 3. Good health; Intensive Care Units; Intensive care; Case-Control Studies; Original Article; Female

Abstract Background: Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients.Aim: To assess the characteristics and outcome of ICU-acquired infections in COVID-19 patients.Methods: In this retrospective single-centre, case-control study, we included 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical and microbiological features, and outcome of ICU-acquired infections.Results: Fifty seven patients (40.7%), developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission, and was significantly associated with the APACHE II score (p=0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%) and urinary tract infection (8%), that were produced by a wide spectrum of Gram positive (55%) and Gram negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock, and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p=0.015), and a longer ICU stay (p<0.001).Conclusions: Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection and it is associated with a high mortality and longer course of ICU stay.