TY - JOUR
T1 - Co-infection and ICU-acquired infection in COIVD-19 ICU patients
T2 - a secondary analysis of the UNITE-COVID data set
AU - Conway Morris, Andrew
AU - Kohler, Katharina
AU - de Corte, Thomas
AU - Ercole, Ari
AU - de Grooth, Harm-Jan
AU - Elbers, Paul W. G.
AU - Povoa, Pedro
AU - Morais, Rui
AU - Koulenti, Despoina
AU - Jog, Sameer
AU - Nielsen, Nathan
AU - Jubb, Alasdair
AU - ESICM UNITE COVID investigators
AU - Cecconi, Maurizio
AU - de Waele, Jan
N1 - Funding Information: We want to thank Guy Francois of the European Society of Intensive Care Medicine for his support. We thank the ESICM COVID UNITE National Coordinators for their help: Bangladesh: Tarikul Hamid; Belgium: Jan De Waele; Brazil: Ederlon Rezende; Canada: Michael Sklar; Chile: Patricio Vargas; China: Bin Du; Colombia: Luis Felipe Reyes; Ecuador: Diego Morocho Tutillo; Germany: Björn Weiss; Greece: Despoina Koulenti; India: Sameer Jog; Ireland: Alistair Nichol; Italy: Katia Donadello; Kenya: Demet S. Sulemanji; Lybia: Muhammed Elhadi; Mexico: Silvio A. Ñmendys-Silva; Netherlands: Paul Elbers; Pakistan: Madiha Hashmi; Peru: Juan Luis Pinedo Portilla; Portugal: Pedro Povoa; Qatar: Abdurrahmaan Ali Elbuzidi; Russian Federation: Vitaly Gusarov; Saudi Arabia: Yaseen Arabi; Singapore Funding Information: European Society of Intensive Care Medicine. ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1). Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract: [Figure not available: see fulltext.].
AB - Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract: [Figure not available: see fulltext.].
UR - http://www.scopus.com/inward/record.url?scp=85135501518&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13054-022-04108-8
DO - https://doi.org/10.1186/s13054-022-04108-8
M3 - Article
C2 - 35922860
SN - 1466-609X
VL - 26
SP - 236
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 236
ER -