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Published on: September 24, 2020
Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center
Nando Bloch1, Susanne Rüfenacht2, Magdalena Ludwinek2
1Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland. nando.bloch@kssg.ch.
Insights
COVID-19 patients in intensive care units (ICUs) had a higher incidence of healthcare-associated infections (HAIs), particularly pulmonary infections. A COVID-19 diagnosis was an independent risk factor for HAI development.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The COVID-19 pandemic has been linked to increased healthcare-associated infections (HAIs) in intensive care units (ICUs).
- The precise reasons for this increase, whether direct or indirect effects of COVID-19, remain unclear.
- This study aimed to evaluate HAI incidence and risk factors in ICU patients with and without COVID-19.
Purpose of the Study:
- To assess healthcare-associated infection (HAI) incidence in intensive care unit (ICU) patients during the COVID-19 pandemic.
- To identify independent risk factors for HAI development in both COVID-19 and non-COVID-19 ICU patients.
- To differentiate between direct and indirect impacts of COVID-19 on HAI rates.
Main Methods:
- A prospective surveillance study was conducted in a medical ICU over one year, including patients with ICU stays exceeding two days.
- Healthcare-associated infections (HAIs) were defined using European Centre for Disease Prevention and Control criteria.
- Multivariable Cox regression was used to identify independent risk factors, with COVID-19 status and institutional COVID-19 burden as key variables.
Main Results:
- A total of 254 patients were included: 64 with COVID-19 and 190 without.
- The HAI incidence rate was significantly higher in COVID-19 patients (49.1/1,000 patient-days) compared to non-COVID-19 patients (22.5/1,000 patient-days).
- Ventilator-associated lower respiratory tract infections (VA-LRTI) were the primary driver of the increased HAI rate in COVID-19 patients.
Conclusions:
- COVID-19 patients in the ICU experienced a higher incidence of HAIs, predominantly pulmonary infections.
- A COVID-19 diagnosis was identified as an independent risk factor for HAI development.
- Institutional COVID-19 burden did not emerge as a significant independent risk factor for HAI.
Background:
The coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients.
Methods:
We established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable.
Results:
We included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4-3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant.
Conclusions:
These data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.
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