TY - JOUR
T1 - Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients
AU - Buehler, Philipp K.
AU - Zinkernagel, Annelies S.
AU - Hofmaenner, Daniel A.
AU - Wendel Garcia, Pedro David
AU - Acevedo, Claudio T.
AU - Gómez-Mejia, Alejandro
AU - Mairpady Shambat, Srikanth
AU - Andreoni, Federica
AU - Maibach, Martina A.
AU - Bartussek, Jan
AU - Hilty, Matthias P.
AU - Frey, Pascal M.
AU - Schuepbach, Reto A.
AU - Brugger, Silvio D.
N1 - Funding Information: Funding was provided from Promedica Foundation 1449/M to S.D.B., University of Zurich CRPP Precision medicine for bacterial infections to A.S.Z., and unrestricted funds to R.A.S. The funders had no role in study design, performance, analysis, and interpretation of findings. Publisher Copyright: © 2021
PY - 2021/4/20
Y1 - 2021/4/20
N2 - The impact of secondary bacterial infections (superinfections) in coronavirus disease 2019 (COVID-19) is not well understood. In this prospective, monocentric cohort study, we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages, and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days [VFDs] at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37; 95% confidence interval [CI] 0.15–0.90; p = 0.028). Patients with pulmonary superinfections have a higher incidence of bacteremia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy.
AB - The impact of secondary bacterial infections (superinfections) in coronavirus disease 2019 (COVID-19) is not well understood. In this prospective, monocentric cohort study, we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages, and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days [VFDs] at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37; 95% confidence interval [CI] 0.15–0.90; p = 0.028). Patients with pulmonary superinfections have a higher incidence of bacteremia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy.
KW - ARDS
KW - COVID-19
KW - SARS-CoV-2
KW - acute respiratory distress syndrome
KW - antibiotic therapy
KW - bacterial superinfection
KW - co-infection
KW - coronavirus disease 19
KW - invasive mechanical ventilation
KW - longitudinal sampling
KW - severe acute respiratory syndrome coronavirus 2
KW - ventilator free at 28 days
UR - http://www.scopus.com/inward/record.url?scp=85103343380&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.xcrm.2021.100229
DO - https://doi.org/10.1016/j.xcrm.2021.100229
M3 - Article
C2 - 33748789
SN - 2666-3791
VL - 2
JO - Cell Reports Medicine
JF - Cell Reports Medicine
IS - 4
M1 - 100229
ER -