Epidemiological and Clinical Characterization of Superinfections in Critically Ill Coronavirus Disease 2019 Patients

Liana Signorini, MD; Giovanni Moioli, MD; Stefano Calza, PhD; Evelyn Van Hauwermeiren, MD; Silvia Lorenzotti, MD; Giovanni Del Fabro, MD; Giulia Renisi, MD; Paola Lanza, MD; Barbara Saccani, MD; Giulia Zambolin, MD; Nicola Latronico, MD; Francesco Castelli, MD; Sergio Cattaneo, MD; John C. Marshall, MD; Alberto Matteelli, MD; Simone Piva, MD

doi:10.1097/CCE.0000000000000430

Critical Care Explorations (Jun 2021)

Epidemiological and Clinical Characterization of Superinfections in Critically Ill Coronavirus Disease 2019 Patients

Liana Signorini, MD,
Giovanni Moioli, MD,
Stefano Calza, PhD,
Evelyn Van Hauwermeiren, MD,
Silvia Lorenzotti, MD,
Giovanni Del Fabro, MD,
Giulia Renisi, MD,
Paola Lanza, MD,
Barbara Saccani, MD,
Giulia Zambolin, MD,
Nicola Latronico, MD,
Francesco Castelli, MD,
Sergio Cattaneo, MD,
John C. Marshall, MD,
Alberto Matteelli, MD,
Simone Piva, MD

Affiliations

Liana Signorini, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Giovanni Moioli, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Stefano Calza, PhD: 2 Unit of Biostatistics and Biomathematics & Unit of Bioinformatics, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
Evelyn Van Hauwermeiren, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Silvia Lorenzotti, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Giovanni Del Fabro, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Giulia Renisi, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Paola Lanza, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Barbara Saccani, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Giulia Zambolin, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Nicola Latronico, MD: 5 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Francesco Castelli, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Sergio Cattaneo, MD: 8 Division of Cardio-Thoracic Intensive Care, ASST Spedali Civili, Brescia, Italy.
John C. Marshall, MD: 9 Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, ON, Canada.
Alberto Matteelli, MD: 1 Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
Simone Piva, MD: 5 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.

DOI: https://doi.org/10.1097/CCE.0000000000000430
Journal volume & issue: Vol. 3, no. 6
p. e0430

Abstract

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OBJECTIVES:. To describe the epidemiology of superinfections (occurring > 48 hr after hospital admission) and their impact on the ICU and 28-day mortality in patients with coronavirus disease 2019 with acute respiratory distress syndrome, requiring mechanical ventilation. DESIGN:. Retrospective analysis of prospectively collected observational data. SETTING:. University-affiliated adult ICU. PATIENTS:. Ninety-two coronavirus disease 2019 patients admitted to the ICU from February 21, 2020, to May 6, 2020. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. The prevalence of superinfection at ICU admission was 21.7%, and 53 patients (57.6%) had at least one superinfection during ICU stay, with a total of 75 (82%) ventilator-associated pneumonia and 57 (62%) systemic infections. The most common pathogens responsible for ventilator-associated pneumonia were Pseudomonas aeruginosa (n = 26, 34.7%) and Stenotrophomonas maltophilia (n = 14, 18.7%). Bloodstream infection occurred in 16 cases, including methicillin-resistant Staphylococcus epidermidis (n = 8, 14.0%), Enterococcus species (n = 6, 10.5%), and Streptococcus species (n = 2, 3.5%). Fungal infections occurred in 41 cases, including 36 probable (30 by Candida albicans, six by C. nonalbicans) and five proven invasive candidiasis (three C. albicans, two C. nonalbicans). Presence of bacterial infections (odds ratio, 10.53; 95% CI, 2.31–63.42; p = 0.005), age (odds ratio, 1.17; 95% CI, 1.07–1.31; p = 0.001), and the highest Sequential Organ Failure Assessment score (odds ratio, 1.27; 95% CI, 1.06–1.63; p = 0.032) were independently associated with ICU or 28-day mortality. CONCLUSIONS:. Prevalence of superinfections in coronavirus disease 2019 patients requiring mechanical ventilation was high in this series, and bacterial superinfections were independently associated with ICU or 28-day mortality (whichever comes first).

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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