Bacterial Coinfection in Critically Ill Patients With COVID-19

Intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) have an increased risk of bacterial coinfections, including ventilator-associated pneumonia (VAP), bloodstream infections (BSI) and catheter-associated urinary tract infections (CA-UTI). The objective was to investigate the prevalence, risk factors and spectrum of bacterial coinfections in patients with COVID-19 admitted to the ICU. It is a single-centre retrospective cohort study. Data from 201 patients with COVID-19 admitted to the University Clinical Intensive Care Hospital in Bialystok, Poland, between March 2020 and July 2021 were analysed. The prevalence of coinfections, risk factors and causative agents were assessed. Objective comparisons of data were performed by evaluating related studies and reviews. Bacterial coinfections developed in 70% of the 201 patients studied. The most frequent types were VAP, occurring in 47.5% of patients with bacterial coinfections, BSI and CA-UTI. Prolonged ventilatory support (mean duration of 13.3 days in the bacterial coinfection group) and prolonged ICU stay (mean of 15.3 days) were associated with an increased risk of these infections. The predominant pathogens were Klebsiella pneumoniae and Staphylococcus aureus , with Klebsiella pneumoniae extended spectrum beta-lactamases (ESBL) being the most frequently isolated pathogen after 48 h of ICU admission, detected in 121 instances. Bacterial coinfections are common in COVID-19 patients in the ICU and are associated with specific risk factors and pathogens. Vigilant monitoring, antimicrobial stewardship and infection prevention measures are needed to improve patient outcomes.