Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study.
Journal
The Journal of antimicrobial chemotherapy
ISSN: 1460-2091
Titre abrégé: J Antimicrob Chemother
Pays: England
ID NLM: 7513617
Informations de publication
Date de publication:
12 03 2021
12 03 2021
Historique:
received:
22
08
2020
accepted:
28
11
2020
pubmed:
30
12
2020
medline:
25
3
2021
entrez:
29
12
2020
Statut:
ppublish
Résumé
Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19. To identify predictors of superinfections in COVID-19. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 33374002
pii: 6055075
doi: 10.1093/jac/dkaa530
pmc: PMC7799007
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1078-1084Investigateurs
Sabrina Agostini O Degl'Innocenti
(SA)
Greta Barbieri
(G)
Martina Biancalana
(M)
Matteo Borselli
(M)
Elia Nencini
(E)
Stefano Spinelli
(S)
Rachele Antognoli
(R)
Valeria Calsolario
(V)
Fabio Monzani
(F)
Simone Paterni
(S)
Rubia Baldassarri
(R)
Pietro Bertini
(P)
Giulia Brizzi
(G)
Alessandra Della Rocca
(AD)
Paolo Malacarne
(P)
Marco Monfroni
(M)
Chiara Piagnani
(C)
Nicoletta Carpenè
(N)
Laura Carrozzi
(L)
Alessandro Celi
(A)
Massimiliano Desideri
(M)
Marco Gherardi
(M)
Massimiliano Serradori
(M)
Francesco Cinotti
(F)
Alessandro Cipriano
(A)
Naria Park
(N)
Giovanna Forotti
(G)
Alessandro Mengozzi
(A)
Stefano Masi
(S)
Francesca Ruberti
(F)
Maria Sciuto
(M)
Agostino Virdis
(A)
Fabrizio Maggi
(F)
Valentina Galfo
(V)
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.