Hospital-Acquired Infections in Critically Ill Patients With COVID-19
Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19. What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients? Multicenter retrospective analysis of prospect...
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| Published in | Chest Vol. 160; no. 2; pp. 454 - 465 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
01.08.2021
American College of Chest Physicians. Published by Elsevier Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0012-3692 1931-3543 1931-3543 |
| DOI | 10.1016/j.chest.2021.04.002 |
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| Abstract | Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19.
What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients?
Multicenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs.
Of the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001).
Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality.
ClinicalTrials.gov; No.: NCT04388670; URL: www.clinicaltrials.gov
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| AbstractList | Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19.
What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients?
Multicenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs.
Of the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001).
Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality.
ClinicalTrials.gov; No.: NCT04388670; URL: www.clinicaltrials.gov
[Display omitted] Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19.BACKGROUNDFew small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19.What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients?RESEARCH QUESTIONWhat characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients?Multicenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs.STUDY DESIGN AND METHODSMulticenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs.Of the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001).RESULTSOf the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001).Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality.INTERPRETATIONCritically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality.ClinicalTrials.gov; No.: NCT04388670; URL: www.clinicaltrials.gov.TRIAL REGISTRYClinicalTrials.gov; No.: NCT04388670; URL: www.clinicaltrials.gov. Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19. What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients? Multicenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs. Of the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001). Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality. ClinicalTrials.gov; No.: NCT04388670; URL: www.clinicaltrials.gov. |
| Author | Bonfanti, Paolo Greco, Massimiliano Raviglione, Mario Scudeller, Luigia Pesenti, Antonio Viale, Pierluigi Bartoletti, Michele Fior, Gabriele Linguadoca, Sara Ferlicca, Daniela Stefanini, Flavia Mangioni, Davide Forastieri, Andrea Messina, Antonio Ranieri, Marco Bottino, Nicola Guzzardella, Amedeo Cutuli, Salvatore Lucio Muscatello, Antonio De Pascale, Gennaro Girardis, Massimo Monti, Gianpaola Foti, Giuseppe Coloretti, Irene Bandera, Alessandra Bellani, Giacomo Scaravilli, Vittorio Cecconi, Maurizio Biagioni, Emanuela Fumagalli, Roberto Morelli, Paola Alagna, Laura Tonetti, Tommaso Grasselli, Giacomo Gori, Andrea Meschiari, Marianna Redaelli, Simone Antonelli, Massimo Franzetti, Marco |
| Author_xml | – sequence: 1 givenname: Giacomo surname: Grasselli fullname: Grasselli, Giacomo organization: Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 2 givenname: Vittorio surname: Scaravilli fullname: Scaravilli, Vittorio organization: Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 3 givenname: Davide surname: Mangioni fullname: Mangioni, Davide organization: Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 4 givenname: Luigia surname: Scudeller fullname: Scudeller, Luigia organization: Direzione Scientifica, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 5 givenname: Laura surname: Alagna fullname: Alagna, Laura organization: Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 6 givenname: Michele surname: Bartoletti fullname: Bartoletti, Michele organization: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant’Orsola Malpighi, University of Bologna, Bologna, Italy – sequence: 7 givenname: Giacomo surname: Bellani fullname: Bellani, Giacomo organization: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy – sequence: 8 givenname: Emanuela surname: Biagioni fullname: Biagioni, Emanuela organization: Department of Anesthesia and Intensive Care Unit, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy – sequence: 9 givenname: Paolo surname: Bonfanti fullname: Bonfanti, Paolo organization: Infectious Diseases Unit, San Gerardo Hospital ASST Monza, Monza, Italy – sequence: 10 givenname: Nicola surname: Bottino fullname: Bottino, Nicola organization: Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 11 givenname: Irene surname: Coloretti fullname: Coloretti, Irene organization: Department of Anesthesia and Intensive Care Unit, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy – sequence: 12 givenname: Salvatore Lucio surname: Cutuli fullname: Cutuli, Salvatore Lucio organization: Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy – sequence: 13 givenname: Gennaro surname: De Pascale fullname: De Pascale, Gennaro organization: Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy – sequence: 14 givenname: Daniela surname: Ferlicca fullname: Ferlicca, Daniela organization: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy – sequence: 15 givenname: Gabriele surname: Fior fullname: Fior, Gabriele organization: Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy – sequence: 16 givenname: Andrea surname: Forastieri fullname: Forastieri, Andrea organization: Department of Anesthesia and Intensive Care, A. Manzoni Hospital, ASST Lecco, Lecco, Italy – sequence: 17 givenname: Marco surname: Franzetti fullname: Franzetti, Marco organization: Infectious Diseases Unit, A. Manzoni Hospital, ASST Lecco, Lecco, Italy – sequence: 18 givenname: Massimiliano surname: Greco fullname: Greco, Massimiliano organization: Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy – sequence: 19 givenname: Amedeo surname: Guzzardella fullname: Guzzardella, Amedeo organization: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy – sequence: 20 givenname: Sara surname: Linguadoca fullname: Linguadoca, Sara organization: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy – sequence: 21 givenname: Marianna surname: Meschiari fullname: Meschiari, Marianna organization: Infectious Diseases Clinics, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy – sequence: 22 givenname: Antonio surname: Messina fullname: Messina, Antonio organization: Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy – sequence: 23 givenname: Gianpaola surname: Monti fullname: Monti, Gianpaola organization: Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy – sequence: 24 givenname: Paola surname: Morelli fullname: Morelli, Paola organization: Infectious Disease Unit, Hospital Health Direction, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy – sequence: 25 givenname: Antonio surname: Muscatello fullname: Muscatello, Antonio organization: Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 26 givenname: Simone surname: Redaelli fullname: Redaelli, Simone organization: Department of Anesthesia and Intensive Care, A. Manzoni Hospital, ASST Lecco, Lecco, Italy – sequence: 27 givenname: Flavia surname: Stefanini fullname: Stefanini, Flavia organization: Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy – sequence: 28 givenname: Tommaso surname: Tonetti fullname: Tonetti, Tommaso organization: Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy – sequence: 29 givenname: Massimo surname: Antonelli fullname: Antonelli, Massimo organization: Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy – sequence: 30 givenname: Maurizio surname: Cecconi fullname: Cecconi, Maurizio organization: Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center—IRCCS, Rozzano, Milan, Italy – sequence: 31 givenname: Giuseppe surname: Foti fullname: Foti, Giuseppe organization: Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy – sequence: 32 givenname: Roberto surname: Fumagalli fullname: Fumagalli, Roberto organization: Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy – sequence: 33 givenname: Massimo surname: Girardis fullname: Girardis, Massimo organization: Department of Anesthesia and Intensive Care Unit, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy – sequence: 34 givenname: Marco surname: Ranieri fullname: Ranieri, Marco organization: Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy – sequence: 35 givenname: Pierluigi surname: Viale fullname: Viale, Pierluigi organization: Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant’Orsola Malpighi, University of Bologna, Bologna, Italy – sequence: 36 givenname: Mario surname: Raviglione fullname: Raviglione, Mario organization: Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy – sequence: 37 givenname: Antonio surname: Pesenti fullname: Pesenti, Antonio organization: Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 38 givenname: Andrea surname: Gori fullname: Gori, Andrea email: andrea.gori@unimi.it organization: Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy – sequence: 39 givenname: Alessandra surname: Bandera fullname: Bandera, Alessandra organization: Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33857475$$D View this record in MEDLINE/PubMed |
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| Snippet | Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19.
What characteristics in critically ill patients with... Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19.BACKGROUNDFew small studies have described... |
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| SubjectTerms | Aged Chest Infections: Original Research COVID-19 COVID-19 - complications critical care Critical Illness Cross Infection - complications Cross Infection - epidemiology Female hospital-acquired infections Humans Male Middle Aged Pneumonia, Ventilator-Associated - complications Pneumonia, Ventilator-Associated - epidemiology Retrospective Studies SARS-CoV-2 Sepsis - complications Sepsis - epidemiology |
| Title | Hospital-Acquired Infections in Critically Ill Patients With COVID-19 |
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