The Effect of Secondary Infections on Mortality in Patients with COVID-19 Associated Severe ARDS

Abstract

Objective: In the beginning of the coronavirus disease-2019 (COVID-19) pandemic, secondary bacterial, fungal and viral infections have been reported in the intensive care unit (ICU), but there is limited experience with infections in critically ill patients over time. The aim this study was to evaluate the characteristics of secondary infections related to ICU and their effects on mortality in COVID-19 patients. Materials and Methods: Our study was planned as a retrospective single-center case-control study involving 145 patients with severe severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia hospitalized in the ICU between March and June 2020. The epidemiological, clinical and microbiological characteristics and results of ICU-related infections were evaluated. Results: The mean age of the patients was 61.2 years and mean body mass index was 28 kg/m2. At least one comorbidity was found in 140 patients (96.6%). Seventy seven of (53.1%) the patients diagnosed with COVID-19 included in the study died. In addition to SARS-CoV-2, the isolation of different pathogens was observed in 62 (42.75%) patients’ samples. In the group with secondary infections, a significant increase in lymphocyte and lactate levels was observed between the time of admission and time of sampling culture (p<0.001). There was statistical significance in lymphocyte (p<0.026 ) and lactate (p<0.020) levels between the groups with and without infection. There was a significant increase in C-reactive protein, ferritin, procalcitonin levels and Acute Physiology and Chronic Health Evaluation-II scores in the group with secondary infection compared to the group without secondary infection (p<0.041, p<0.009 p<0.001, and p=0.028, respectively). In the group without secondary infection, the D-dimer levels patients were significantly lower (p<0.014). Conclusion: In conclusion, bacterial and fungal secondary infections are a common complication in patients with COVID-19 admitted to the ICU. It usually occurs as a severe form of infection accompanying comorbidity and is associated with high mortality and prolonged ICU stay.

Keywords

• covid-19
• intensive care unit
• co-infection
• mortality