Are bacterial coinfections really rare in COVID-19 intensive care units?
Banu Karaca1, Murat Aksun2, Nagihan Altıncı Karahan2
1Infectious Diseases Department, Faculty of Medicine, Atatürk Training and Research Hospital, Katip Celebi University, Basin Sitesi/Karabaglar, 35360, Izmir, Turkey. banukaraca@yahoo.com.
Objectives:
There are limited data about nosocomial coinfections of COVID-19 cases monitored in the intensive care unit. This study aims to investigate coinfections in COVID-19 patients followed in an intensive care unit of a university hospital.
Methods:
This study analyzed retrospectively the data of coinfections of 351 COVID-19 patients in the period 28.02.2020-15.01.2021 in a tertiary care intensive care unit in a university hospital.
Results:
Bacterial coinfections were present in 216 of the 351 cases. One hundred and thirty of these cases were evaluated as nosocomial infections. On the third day the Sequential Organ Failure Assessment Score, usage of invasive mechanical ventilation and presence of septic shock were significantly higher in the coinfected group. The neutrophil/lymphocyte ratio, polymorphonuclear leukocyte count, procalcitonin, ferritin, and blood urea nitrogen values were significantly higher in the coinfection group. White blood cells (WBC) (OR: 1.075, 95% CI 1.032-1.121, p = 0.001) and ICU hospitalization day (OR: 1.114, 95% CI 1.063-1.167, p < 0.001) were found to be independent risk factors for coinfection in the multivariate logistic regression analysis. The rates of hospitalization day on the day of arrival, the 21st day, as well as total mortality (p = 0.004), were significantly higher in the coinfected group.
Conclusion:
Bacterial coinfections of COVID-19 patients in the intensive care unit remain a problem. Identifying the infectious agent, classifying colonizations and infections, and using the proper treatment of antibiotics are of great importance in the case management of COVID-19 patients in the intensive care unit.
Insights
Bacterial coinfections are common in intensive care unit (ICU) COVID-19 patients, increasing mortality. Early identification and proper antibiotic treatment are crucial for managing these coinfections in critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Limited data exist on nosocomial coinfections in intensive care unit (ICU) COVID-19 patients.
- Coinfections pose a significant challenge in managing critically ill COVID-19 patients.
Purpose of the Study:
- To investigate the prevalence and impact of coinfections in COVID-19 patients admitted to a university hospital's ICU.
- To identify risk factors associated with coinfections in this patient population.
Main Methods:
- Retrospective analysis of 351 COVID-19 patients admitted to a tertiary care ICU between February 28, 2020, and January 15, 2021.
- Evaluation of coinfection data, including bacterial coinfections and nosocomial infections.
- Multivariate logistic regression analysis to identify independent risk factors for coinfection.
Main Results:
- Bacterial coinfections were identified in 216 (61.5%) of 351 COVID-19 patients, with 130 (37%) classified as nosocomial.
- Coinfected patients exhibited higher Sequential Organ Failure Assessment scores, increased use of mechanical ventilation, and higher rates of septic shock.
- Independent risk factors for coinfection included elevated white blood cell (WBC) count and longer ICU hospitalization duration.
- Coinfected patients had significantly higher mortality rates and longer hospital stays.
Conclusions:
- Bacterial coinfections represent a significant ongoing problem for COVID-19 patients in the ICU.
- Prompt identification of infectious agents, differentiation between colonization and infection, and appropriate antibiotic therapy are vital for improving outcomes.
- Effective management strategies are essential to reduce the morbidity and mortality associated with coinfections in critically ill COVID-19 patients.
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