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Research Article
Rafael Lessa da Costa
Unimed-Rio Hospital
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Background: some studies have shown that superinfection during pandemics may have contributed to high mortality. Our objective is to identify the frequency, types and aetiology of superinfections in patients with Covid-19 admitted to the intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and hospital mortality.
Methods: retrospective cohort of adult patients admitted to the ICU for more than 48 hours between March to May 2020. Comparisons of groups with and without ICU- acquired infection were established.
Results: a total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. Most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% Acinetobacter and in 57% K.pneumoniae. The most prevalent infection was ventilator-associated pneumonia (VAP) in 57.9% of patients with bacterial superinfection, or 17.3% of all COVID-19 patients admitted to ICU, followed by tracheobronchitis, in 26.3%. Patients with superinfection had a longer ICU stay (40.0 vs. 17; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0; p = 0.003). There were 35.6% deaths overall, of which 39.7% of the patients had superinfection; in those who survived, 24.4% had a superinfection (OR 2.041; 95% CI 1.080–3.859).
Conclusion: a high incidence of superinfections was seen, mostly caused by Gram-negative bacteria. The most common infection was VAP. Superinfections were associated with longer ICU stay and MV use and higher mortality.
Keywords
COVID-19, superinfection, healthcare associated infection, intensive care unit, mortality, Gram negatives, multidrug-resistance, ventilator- associated pneumonia.
No competing interests reported.
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This is a preprint. It has not completed peer review.
Research Article
Rafael Lessa da Costa
Unimed-Rio Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 29 Apr, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: some studies have shown that superinfection during pandemics may have contributed to high mortality. Our objective is to identify the frequency, types and aetiology of superinfections in patients with Covid-19 admitted to the intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and hospital mortality.
Methods: retrospective cohort of adult patients admitted to the ICU for more than 48 hours between March to May 2020. Comparisons of groups with and without ICU- acquired infection were established.
Results: a total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. Most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% Acinetobacter and in 57% K.pneumoniae. The most prevalent infection was ventilator-associated pneumonia (VAP) in 57.9% of patients with bacterial superinfection, or 17.3% of all COVID-19 patients admitted to ICU, followed by tracheobronchitis, in 26.3%. Patients with superinfection had a longer ICU stay (40.0 vs. 17; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0; p = 0.003). There were 35.6% deaths overall, of which 39.7% of the patients had superinfection; in those who survived, 24.4% had a superinfection (OR 2.041; 95% CI 1.080–3.859).
Conclusion: a high incidence of superinfections was seen, mostly caused by Gram-negative bacteria. The most common infection was VAP. Superinfections were associated with longer ICU stay and MV use and higher mortality.
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