Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Medientyp: E-Artikel
Titel: Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set
Beteiligte: Conway Morris, Andrew; Kohler, Katharina; De Corte, Thomas; Ercole, Ari; De Grooth, Harm-Jan; Elbers, Paul W. G.; Povoa, Pedro; Morais, Rui; Koulenti, Despoina; Jog, Sameer; Nielsen, Nathan; Jubb, Alasdair; Cecconi, Maurizio; De Waele, Jan; Bezzi, Marco; Gira, Alicia; Eller, Philipp; Hamid, Tarikul; Haque, Injamam Ull; De Buyser, Wim; Cudia, Antonella; De Backer, Daniel; Foulon, Pierre; Collin, Vincent; [...]
Erschienen: Springer Science and Business Media LLC, 2022
Erschienen in: Critical Care
Sprache: Englisch
DOI: 10.1186/s13054-022-04108-8
ISSN: 1364-8535
Schlagwörter: Critical Care and Intensive Care Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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. </jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> <jats:p><jats:italic>Trial registration</jats:italic> ClinicalTrials.gov: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT04836065">NCT04836065</jats:ext-link> (retrospectively registered April 8th 2021).</jats:p> </jats:sec><jats:sec> <jats:title>Graphical abstract</jats:title> </jats:sec>
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