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

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

doi:10.1097/CCE.0000000000000430

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

Crit Care Explor. 2021 Jun 11;3(6):e0430. doi: 10.1097/CCE.0000000000000430. eCollection 2021 Jun.

Authors

Liana Signorini¹, Giovanni Moioli¹, Stefano Calza, Evelyn Van Hauwermeiren¹, Silvia Lorenzotti¹, Giovanni Del Fabro¹, Giulia Renisi¹, Paola Lanza¹, Barbara Saccani¹, Giulia Zambolin¹, Nicola Latronico^{2

3}, Francesco Castelli^{1

4}, Sergio Cattaneo⁵, John C Marshall⁶, Alberto Matteelli^{1

4}, Simone Piva^{2

3}

Affiliations

¹ Division of Infectious and Tropical Diseases, Spedali Civili University Hospital, Brescia, Italy.
² Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
³ Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
⁴ Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁵ Division of Cardio-Thoracic Intensive Care, ASST Spedali Civili, Brescia, Italy.
⁶ Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, ON, Canada.

Abstract

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).

Keywords: acute respiratory distress syndrome; coronavirus disease 2019; critically ill; hospital-acquired infections; superinfection.