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Incidence of Bacterial and Fungal Secondary Infections in COVID-19 Patients Admitted to the ICU
Afnan J Alshrefy1, Rawaa N Alwohaibi1, Shahad A Alhazzaa1
1College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Eastern Province, Saudi Arabia.
Purpose:
Secondary infections have been observed among coronavirus disease 2019 (COVID-19) patients, especially in the intensive care unit (ICU) setting, which is associated with worse clinical outcomes. The current study aimed to investigate the incidence, common pathogens, and outcome of bacterial and fungal secondary infections among ICU patients with COVID-19.
Methods:
A retrospective chart review of all patients admitted to the ICU at King Fahd Hospital of the University in Saudi Arabia. All adult patients aged ≥18 admitted in the ICU for ≥48 hours with positive COVID-19 reverse transcription-polymerase chain reaction test during the period between March 2020 till September 2021 were included.
Results:
Out of 314 critically ill patients, 133 (42.4%) developed secondary infections. The incidence of secondary bacterial infection was 32.5% with Pseudomonas aeruginosa (n = 34), Acinetobacter baumannii (n = 33), and Klebsiella pneumoniae (n = 17) being the predominant pathogens, while secondary fungal infection was 25.2% mainly caused by Candida albicans (n = 43). Invasive mechanical ventilation was significantly associated with the development of secondary bacterial infections (odds ratio [OR] = 17.702, 95% confidence interval [CI] 7.842-39.961, p < 0.001) and secondary fungal infections (OR = 12.914, 95% CI 5.406-30.849, p < 0.001). Mortality among patients with secondary infections was 69.2% (n = 92). Secondary infections were associated with longer hospital and ICU stays with a median of 25 days (interquartile range [IQR] 17-42) and 19 days (IQR 13-32), respectively.
Conclusion:
Bacterial and fungal secondary infections are common among COVID-19 patients admitted to the ICU with a predominance of gram-negative bacteria and Candida species. The development of secondary infections was significantly associated with invasive mechanical ventilation. Poor clinical outcomes have been observed, demonstrated with a prolonged hospital and ICU stays and higher mortality.
Insights
Secondary infections are common in critically ill COVID-19 patients, particularly those on mechanical ventilation. These infections lead to longer hospital stays and significantly higher mortality rates.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Secondary infections are a significant concern for patients with coronavirus disease 2019 (COVID-19), especially in intensive care units (ICUs).
- These infections are linked to adverse clinical outcomes, including increased mortality and prolonged hospital stays.
Purpose of the Study:
- To determine the incidence of bacterial and fungal secondary infections in ICU patients with COVID-19.
- To identify common pathogens responsible for these infections.
- To analyze the outcomes associated with secondary infections in this patient population.
Main Methods:
- A retrospective chart review was conducted at King Fahd Hospital of the University in Saudi Arabia.
- Included were adult patients (≥18 years) admitted to the ICU for at least 48 hours with a positive COVID-19 reverse transcription-polymerase chain reaction test between March 2020 and September 2021.
- Data on secondary infections, pathogens, interventions, and clinical outcomes were extracted.
Main Results:
- Out of 314 patients, 133 (42.4%) developed secondary infections.
- Bacterial infections occurred in 32.5% of patients, with Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae as predominant pathogens.
- Fungal infections occurred in 25.2% of patients, primarily caused by Candida albicans. Invasive mechanical ventilation was strongly associated with both bacterial (OR=17.7) and fungal (OR=12.9) infections. Mortality was high at 69.2% among those with secondary infections, with extended hospital and ICU stays.
Conclusions:
- Bacterial and fungal secondary infections are prevalent in critically ill COVID-19 patients within ICUs.
- Gram-negative bacteria and Candida species are the most common causative agents.
- Secondary infections significantly correlate with invasive mechanical ventilation, leading to poor clinical outcomes including prolonged ICU/hospital stays and increased mortality.
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