Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study
Author:
Falcone Marco1ORCID, Tiseo Giusy1, Giordano Cesira2, Leonildi Alessandro1, Menichini Melissa2, Vecchione Alessandra2, Pistello Mauro3, Guarracino Fabio4, Ghiadoni Lorenzo5, Forfori Francesco6, Barnini Simona2, Menichetti Francesco1, O Degl’Innocenti Sabrina Agostini, Barbieri Greta, Biancalana Martina, Borselli Matteo, Nencini Elia, Spinelli Stefano, Antognoli Rachele, Calsolario Valeria, Monzani Fabio, Paterni Simone, Baldassarri Rubia, Bertini Pietro, Brizzi Giulia, Rocca Alessandra Della, Malacarne Paolo, Monfroni Marco, Piagnani Chiara, Carpenè Nicoletta, Carrozzi Laura, Celi Alessandro, Desideri Massimiliano, Gherardi Marco, Serradori Massimiliano, Cinotti Francesco, Cipriano Alessandro, Park Naria, Forotti Giovanna, Mengozzi Alessandro, Masi Stefano, Ruberti Francesca, Sciuto Maria, Virdis Agostino, Maggi Fabrizio, Galfo Valentina,
Affiliation:
1. Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 2. Microbiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy 3. Virology Unit, Department of Laboratory Medicine Pisa University Hospital and Retrovirus Center, Department of Translational Research, University of Pisa, Pisa, Italy 4. Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy 5. Emergency Medicine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 6. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
Abstract
Abstract
Background
Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19.
Objectives
To identify predictors of superinfections in COVID-19.
Methods
Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections.
Results
Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11–29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5–39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4–13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2–11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7–7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1–7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P < 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445).
Conclusions
The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology,Microbiology (medical)
Cited by
116 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献
|
|