Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study.
J Antimicrob Chemother
; 76(4): 1078-1084, 2021 03 12.
Article
em En
| MEDLINE
| ID: mdl-33374002
ABSTRACT
BACKGROUND:
Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19.OBJECTIVES:
To identify predictors of superinfections in COVID-19.METHODS:
Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections.RESULTS:
Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11-29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5-39.5, Pâ<â0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4-13.1, Pâ<â0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2-11.8, Pâ<â0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7-7.7, Pâ=â0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1-7.2, Pâ=â0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, Pâ<â0.001), while mortality rates were similar (18.8% versus 23.2%, Pâ=â0.445).CONCLUSIONS:
The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
4_TD
/
6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Superinfecção
/
Infecção Hospitalar
/
COVID-19
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Antimicrob Chemother
Ano de publicação:
2021
Tipo de documento:
Article