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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Incidence and Risk Factors for Blood Stream Infection in Mechanically Ventilated COVID-19 Patients
Konstantinos Mantzarlis1, Konstantina Deskata1, Dimitra Papaspyrou1
1Department of Critical Care, University Hospital of Larissa, School of Medicine, University of Thessaly, 41110 Thessaly, Greece.
Abstract:
It is widely known that blood stream infections (BSIs) in critically ill patients may affect mortality, length of stay, or the duration of mechanical ventilation. There is scarce data regarding blood stream infections in mechanically ventilated COVID-19 patients. Preliminary studies report that the number of secondary infections in COVID-9 patients may be higher. This retrospective analysis was conducted to determine the incidence of BSI. Furthermore, risk factors, mortality, and other outcomes were analyzed. The setting was an Intensive Care Unit (ICU) at a University Hospital. Patients suffering from SARS-CoV-2 infection and requiring mechanical ventilation (MV) for >48 h were eligible. The characteristics of patients who presented BSI were compared with those of patients who did not present BSI. Eighty-four patients were included. The incidence of BSI was 57%. In most cases, multidrug-resistant pathogens were isolated. Dyslipidemia was more frequent in the BSI group (p < 0.05). Moreover, BSI-group patients had a longer ICU stay and a longer duration of both mechanical ventilation and sedation (p < 0.05). Deaths were not statistically different between the two groups (73% for BSI and 56% for the non-BSI group, p > 0.05). Compared with non-survivors, survivors had lower baseline APACHE II and SOFA scores, lower D-dimers levels, a higher baseline compliance of the respiratory system, and less frequent heart failure. They received anakinra less frequently and appropriate therapy more often (p < 0.05). The independent risk factor for mortality was the APACHE II score [1.232 (1.017 to 1.493), p = 0.033].
Insights
Bloodstream infections (BSIs) are common in mechanically ventilated COVID-19 patients, often caused by multidrug-resistant pathogens. These infections prolong ICU stays and mechanical ventilation duration, but do not significantly impact mortality.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Bloodstream infections (BSIs) are known complications in critically ill patients, impacting outcomes.
- Data on BSIs in mechanically ventilated COVID-19 patients is limited, with preliminary studies suggesting higher infection rates.
- Secondary infections may be more prevalent in patients with SARS-CoV-2.
Purpose of the Study:
- To determine the incidence of BSIs in mechanically ventilated COVID-19 patients.
- To identify risk factors, mortality, and other outcomes associated with BSIs in this patient population.
- To analyze factors differentiating survivors from non-survivors.
Main Methods:
- Retrospective analysis of 84 mechanically ventilated COVID-19 patients requiring ventilation for over 48 hours.
- Comparison of characteristics between patients with and without BSIs.
- Analysis of risk factors for mortality, including baseline scores and treatments.
Main Results:
- The incidence of BSIs was 57%, frequently involving multidrug-resistant pathogens.
- Dyslipidemia was more common in the BSI group, which also experienced longer ICU stays, mechanical ventilation, and sedation.
- Mortality rates were not statistically different between BSI and non-BSI groups (73% vs. 56%).
- Survivors had lower APACHE II and SOFA scores, lower D-dimers, better respiratory compliance, and less heart failure.
- APACHE II score was the independent risk factor for mortality (p = 0.033).
Conclusions:
- Bloodstream infections are highly prevalent in mechanically ventilated COVID-19 patients, often caused by multidrug-resistant organisms.
- BSIs are associated with prolonged ICU stay and mechanical ventilation but not increased mortality in this cohort.
- APACHE II score is a significant independent predictor of mortality in critically ill COVID-19 patients.
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