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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set
Critical Care, Volume 26, No. 1, Article 236, Year 2022
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Description
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.]. © 2022, The Author(s).
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC9347163/bin/13054_2022_4108_MOESM1_ESM.pdf
https://efashare.b-cdn.net/share/pmc/articles/PMC9347163/bin/13054_2022_4108_MOESM2_ESM.docx
Authors & Co-Authors
Conway-Morris, Andrew
United Kingdom, Cambridge
University of Cambridge
United Kingdom, Cambridge
Addenbrooke's Hospital
Ercole, Ari
United Kingdom, Cambridge
University of Cambridge
United Kingdom, Cambridge
Addenbrooke's Hospital
Elbers, Paul W.G.
Netherlands, Amsterdam
Vrije Universiteit Amsterdam
Póvoa, Pedro R.
Portugal, Lisbon
Universidade Nova de Lisboa
Denmark, Odense
Odense Universitetshospital
Portugal, Lisbon
Hospital São Francisco Xavier
Koulenti, Despoina
Greece, Athens
National and Kapodistrian University of Athens
Australia, Brisbane
The University of Queensland
Jog, Sameer Arvind
India, Pune
Deenanath Mangeshkar Hospital and Research Center, Pune
Jubb, Alasdair W.
United Kingdom, Cambridge
University of Cambridge
United Kingdom, Cambridge
Addenbrooke's Hospital
Cecconi, Maurizio H.
Italy, Pieve Emanuele
Humanitas University
De Waele, Jan J.
Belgium, Ghent
Universitair Ziekenhuis Gent
Belgium, Ghent
Universiteit Gent
Bezzi, Marco Guillermo
Unknown Affiliation
Eller, Philipp
Unknown Affiliation
de Backer, Daniel P.
Unknown Affiliation
de Waele, Elisabeth
Unknown Affiliation
Mesland, Jean Baptiste
Unknown Affiliation
Piagnerelli, Michaël
Unknown Affiliation
Haentjens, Lionel L.
Unknown Affiliation
Bulpa, Pierre A.
Unknown Affiliation
Binnie, Alexandra
Unknown Affiliation
Graf, Jerónimo
Unknown Affiliation
Reyes, Luis F.
Unknown Affiliation
Elmandouh, Omar
Unknown Affiliation
Azzam, Ahmed Y.
Unknown Affiliation
Hussein, Aliae A.R.Mohamed
Unknown Affiliation
Galal, Islam
Unknown Affiliation
Awad, Ahmed K.
Unknown Affiliation
Azab, M. A.
Unknown Affiliation
Abdalla, Maged S.
Unknown Affiliation
Assal, Hebatallah Allah Hany M.
Unknown Affiliation
Alfishawy, Mostafa
Unknown Affiliation
Ghozy, Sherief A.
Unknown Affiliation
Tharwat, Samar
Unknown Affiliation
Eldaly, Abdullah Sami
Unknown Affiliation
Badie, Julio C.
Unknown Affiliation
Weiß, Bjoern
Unknown Affiliation
Kuhn, Karl Friedrich
Unknown Affiliation
Lorenz, Marco
Unknown Affiliation
Schaller, Stefan J.
Unknown Affiliation
Fuest, Kristina E.
Unknown Affiliation
Lahmer, Tobias
Unknown Affiliation
Meybohm, Patrick
Unknown Affiliation
Kalvit, Kushal Rajeev
Unknown Affiliation
Myatra, Sheila Nainan
Unknown Affiliation
Nichol, Alistair D.
Unknown Affiliation
Mahmoodpor, Ata
Unknown Affiliation
Spadaro, S.
Unknown Affiliation
Noto, Alberto
Unknown Affiliation
Guzzardella, Amedeo
Unknown Affiliation
Antonelli, Massimo M.
Unknown Affiliation
Montrucchio, G.
Unknown Affiliation
Donadello, Katia
Unknown Affiliation
Gottin, Leonardo
Unknown Affiliation
Polati, Enrico
Unknown Affiliation
De Rosa, Silvia
Unknown Affiliation
Sülemanji, Demet Sargin
Unknown Affiliation
Abusalama, Abdurraouf A.
Unknown Affiliation
Elhadi, Muhammed K.
Unknown Affiliation
Dendane, Tarek
Unknown Affiliation
Spronk, Peter E.
Unknown Affiliation
Cornet, Alexander Daniel
Unknown Affiliation
van Bussel, Bas C.T.
Unknown Affiliation
Kesecioǧlu, Jozef
Unknown Affiliation
Alasia, Datonye Dennis
Unknown Affiliation
Rana, Muhammad Asim
Unknown Affiliation
Adrião, Diana
Unknown Affiliation
Omrani, Ali S.
Unknown Affiliation
Al-Maslamani, Muna A.Rahman S.
Unknown Affiliation
Elbuzidi, Abdurrahmaan Suei
Unknown Affiliation
Akkari, Abdel Rauof Mahmud
Unknown Affiliation
Bakdach, Dana
Unknown Affiliation
Bintaher, Awadh A.
Unknown Affiliation
Gavrilova, Elena Vasil’evna
Unknown Affiliation
Aljuhani, Ohoud A.
Unknown Affiliation
Alkhalaf, Amina A.
Unknown Affiliation
Arabi, Yaseen M.
Unknown Affiliation
Kuhail, Ahmed
Unknown Affiliation
Ferrando-Ortolá, Carlos
Unknown Affiliation
Galarza, Laura
Unknown Affiliation
Frutos-Vivar, Fernando
Unknown Affiliation
Martín-Delgado, María Cruz
Unknown Affiliation
Ripollés-Melchor, Javier
Unknown Affiliation
Teruel, Santiago Yus
Unknown Affiliation
Cubero, Patricia Patricia
Unknown Affiliation
Pérez-Torres, David
Unknown Affiliation
Serrano, A.
Unknown Affiliation
Ceruti, Samuele
Unknown Affiliation
Yilmaz, Mehmet Birhan
Unknown Affiliation
Saraçoǧlu, Kemal Tolga
Unknown Affiliation
Torlinski, Tomasz
Unknown Affiliation
Čagová, Lenka
Unknown Affiliation
Boulanger, Carole
Unknown Affiliation
Potter, Elizabeth K.
Unknown Affiliation
Szakmany, Tamas
Unknown Affiliation
Marczin, Nándor
Unknown Affiliation
Henning, Jeremy D.R.
Unknown Affiliation
Davey, Miriam
Unknown Affiliation
Grecu, Irina
Unknown Affiliation
Al-Sadawi, Mohammed Adel
Unknown Affiliation
Statistics
Citations: 25
Authors: 97
Affiliations: 13
Identifiers
Doi:
10.1186/s13054-022-04108-8
ISSN:
13648535
Research Areas
Covid
Study Design
Cohort Study
Case-Control Study