학술논문
Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set
Document Type
Report
Author
Conway Morris, Andrew; Kohler, Katharina; De Corte, Thomas; Ercole, Ari; De Grooth, Harm-Jan; Elbers, Paul W. G.; Povoa, Pedro; Morais, Rui; Koulenti, Despoina; Jog, Sameer; Nielsen, Nathan; Jubb, Alasdair; Cecconi, Maurizio; De Waele, Jan; Bezzi, Marco; Gira, Alicia; Eller, Philipp; Hamid, Tarikul; Haque, Injamam Ull; De Buyser, Wim; Cudia, Antonella; De Backer, Daniel; Foulon, Pierre; Collin, Vincent; Van Hecke, Jolien; De Waele, Elisabeth; Van Malderen, Claire; Mesland, Jean-Baptiste; Piagnerelli, Michael; Haentjens, Lionel; De Schryver, Nicolas; Van Leemput, Jan; Vanhove, Philippe; Bulpa, Pierre; Ilieva, Viktoria; Katz, David; Geagea, Anna; Binnie, Alexandra; Tirapegui, Fernando; Lago, Gustavo; Graf, Jerónimo; Perez-Araos, Rodrigo; Vargas, Patricio; Martinez, Felipe; Labarca, Eduardo; Franco, Daniel Molano; Parra-Tanoux, Daniela; Reyes, Luis Felipe; Yepes, David; PeriÅ¡, Filip; StipiÄ, Sanda StojanoviÄ; Burgos, Cynthia Vanessa Campozano; Boada, Paulo Roberto Navas; Brun, Jose Luis Barberan; Ballesteros, Juan Pablo Paredes; Hammouda, Ahmed; Elmandouh, Omar; Azzam, Ahmed; Hussein, Aliae Mohamed; Galal, Islam; Awad, Ahmed K.; Azab, Mohammed A.; Abdalla, Maged; Assal, Hebatallah; Alfishawy, Mostafa; Ghozy, Sherief; Tharwat, Samar; Eldaly, Abdullah; Reinhard, Veronika; Chrisment, Anne; Poyat, Chrystelle; Badie, Julio; Ferrari, Fernando Berdaguer; Weiss, Björn; Kuhn, Karl Friedrich; Grunow, Julius J.; Lorenz, Marco; Schaller, Stefan; Spieth, Peter; Bota, Marc; Fichtner, Falk; Fuest, Kristina; Lahmer, Tobias; Herrmann, Johannes; Meybohm, Patrick; Markou, Nikolaos; Vasileiadou, Georgia; Chrysanthopoulou, Evangelia; Papamichalis, Panagiotis; Soultati, Ioanna; Kalvit, Kushal; Myatra, Sheila Nainan; Krupa, Ivan; Tharwat, Aisa; Nichol, Alistair; McCarthy, Aine; Mahmoodpoor, Ata; Tonetti, Tommaso; Isoni, Paolo; Spadaro, Savino; Volta, Carlo Alberto; Mirabella, Lucia; Noto, Alberto; Florio, Gaetano; Guzzardella, Amedeo; Paleari, Chiara; Baccanelli, Federica; Savi, Marzia; Antonelli, Massimo; Vaccarini, Barbara; Montrucchio, Giorgia; Sales, Gabriele; Donadello, Katia; Gottin, Leonardo; Polati, Enrico; De Rosa, Silvia; Sulemanji, Demet; Abusalama, Abdurraouf; Elhadi, Muhammed; De Jesus, Montelongo Felipe; Gonzalez, Daniel Rodriguez; Canedo, Nancy; Chavez, Alejandro Esquivel; Dendane, Tarek; Grady, Bart; de Jong, Ben; van der Heiden, Eveline; Thoral, Patrick; van den Bogaard, Bas; Spronk, Peter E.; Achterberg, Sefanja; Groeneveld, Melanie; So, Ralph K. L.; de Wijs, Calvin; Scholten, Harm; Beishuizen, Albertus; Cornet, Alexander D.; Reidinga, Auke C.; Kranen, Hetty; Mensink, Roos; Boer, Sylvia den; de Groot, Marcel; Beck, Oliver; Bethlehem, Carina; van Bussel, Bas; Frenzel, Tim; de Jong, Celestine; Wilting, Rob; Kesecioglu, Jozef; Mehagnoul-Schipper, Jannet; Alasia, Datonye; Kumar, Ashok; Qayyum, Ahad; Rana, Muhammad; Jayyab, Mustafa Abu; Sierra, Rosario Quispe; Hernandez, Aaron Mark; Taborda, Lúcia; Ramires, Tiago; Silva, Catarina; Roriz, Carolina; Póvoa, Pedro; Patricio, Patricia; Santos, Maria Lurdes; Costa, Vasco; Cunha, Pedro; Gonçalves, Celina; Nunes, Sandra; Camões, João; Adrião, Diana; Oliveira, Ana; Omrani, Ali; Al Maslamani, Muna; elbuzidi, Abdurrahmaan Suei; Al qudah, Bara Mahmoud; Akkari, Abdel Rauof; Alkhatteb, Mohamed; Baiou, Anas; Husain, Ahmed; Alwraidat, Mohamed; Saif, Ibrahim Abdulsalam; Bakdach, Dana; Ahmed, Amna; Aleef, Mohamed; Bintaher, Awadh; Petrisor, Cristina; Popov, Evgeniy; Popova, Ksenia; Dementienko, Mariia; Teplykh, Boris; Pyregov, Alexey; Davydova, Liubov; Vladislav, Belskii; Neporada, Elena; Zverev, Ivan; Meshchaninova, Svetlana; Sokolov, Dmitry; Gavrilova, Elena; Shlyk, Irena; Poliakov, Igor; Bлacoвa, Mapинa; Aljuhani, Ohoud; Alkhalaf, Amina; Humaid, Felwa Bin; Arabi, Yaseen; Kuhail, Ahmed; Elrabi, Omar; Alghnam, Madihah; Kansal, Amit; Ho, Vui Kian; Ng, Jensen; García, Raquel Rodrígez; Fraga, Xiana Taboada; del Pilar García-Bonillo, Mª; Padilla-Serrano, Antonio; Cuadrado, Marta Martin; Ferrando, Carlos; Catalan-Monzon, Ignacio; Galarza, Laura; Frutos-Vivar, Fernando; Jimenez, Jorge; Rodríguez-Solis, Carmen; Franquesa-Gonzalez, Enric; Acosta, Guillermo Pérez; Cabrera, Luciano Santana; Parra, Juan Pablo Aviles; Gonzalez, Francisco Muéoyerro; del Carmen Lorente Conesa, Maria; Varela, Ignacio Yago Martinez; Pravia, Orville Victoriano Baez; Delgado, Maria Cruz Martin; de Cabo, Carlos Munoz; Ioan, Ana-Maria; Perez-Calvo, Cesar; Santos, Arnoldo; Abad-Motos, Ane; Ripolles-Melchor, Javier; Martin, Belén Civantos; Teruel, Santiago Yus; Lucas, Juan Higuera; Ortiz, Aaron Blandino; de Pablo Sánchez, Raúl; Barrueco-Francioni, Jesús Emilio; Espina, Lorena Forcelledo; Bonell-Goytisolo, José M.; Salaverria, Iéigo; Mir, Antonia Socias; Rodriguez-Ruiz, Emilio; Valverde, Virginia Hidalgo; Cubero, Patricia Jimeno; Linde, Francisca Arbol; Leganes, Nieves Cruza; Romeu, Juan Maria; Concha, Pablo; Berezo-Garcia, José Angel; Fraile, Virginia; Cuenca-Rubio, Cristina; Perez-Torres, David; Serrano, Ainhoa; Valero, Clara Martínez; Suner, Andrea Ortiz; Larraéaga, Leire; Legaristi, Noemi; Ferrigno, Gerardo; Khlafalla, Safa; Bihariesingh-Sanchit, Rosita; Zoerner, Frank; Grip, Jonathan; Kilsand, Kristina; üsterlind, Jonas; von Seth, Magnus; Berkius, Johan; Ceruti, Samuele; Glotta, Andrea; Izdes, Seval; Turan, IÅil üzkoçak; Cosar, Ahmet; Halacli, Burcin; Dereli, Necla; Yilmaz, Mehmet; Akbas, Türkay; Elay, Gülseren; EyüpoÄlu, Selin; Bílír, Yelíz; SaraçoÄlu, Kemal Tolga; Kaya, Ebru; Sahin, Ayca Sultan; Ekren, Pervin Korkmaz; Mengi, TuÄçe; Suner, Kezban Ozmen; Tomak, Yakup; Eroglu, Ahmet; Alsabbah, Asad; Hanlon, Katie; Gervin, Kevin; McMahon, Sean; Hagan, Samantha; Higenbottam, Caroline V.; Mullhi, Randeep; Poulton, Lottie; Torlinski, Tomasz; Gareth, Allen; Truman, Nick; Vijayakumar, Gopal; Hall, Chris; Cagova, Lenka; Jones, Nicola; Graham, Sam; Robin, Nicole; Cowton, Amanda; Donnelly, Adrian; Singatullina, Natalia; Kent, Melanie; Boulanger, Carole; Campbell, Zoë; Potter, Elizabeth; Duric, Natalie; Szakmany, Tamas; Kviatkovske, Orinta; Marczin, Nandor; Ellis, Caroline; Saha, Rajnish; Sri-Chandana, Chunda; Allan, John; Mumelj, Lana; Venkatesh, Harish; Gotz, Vera Nina; Cochrane, Anthony; Lumlertgul, Nuttha; Ficial, Barbara; Jain, Susan; Crapelli, Giulia Beatrice; Vlachou, Aikaterini; Golden, David; Garrioch, Sweyn; Henning, Jeremy; Loveleena, Gupta; Davey, Miriam; Grauslyte, Lina; Salciute-Simene, Erika; Cook, Martin; Barling, Danny; Broadhurst, Phil; Purvis, Sarah; Michael, Spivey; Shuker, Benjamin; Grecu, Irina; Harding, Daniel; Dean, James T.; Nielsen, Nathan D.; Al-Bayati, Sama; Al-Sadawi, Mohammed; Charron, Mariane; Stubenrauch, Peter; Santanilla, Jairo; Wentowski, Catherine; Rosenberger, Dorothea; Eksarko, Polikseni; Jawa, Randeep
Source
Critical Care. August 3, 2022, Vol. 26 Issue 1
Subject
Language
English
ISSN
1364-8535
Abstract
Author(s): Andrew Conway Morris[sup.1,2,3] , Katharina Kohler[sup.1] , Thomas De Corte[sup.4,5] , Ari Ercole[sup.1,6] , Harm-Jan De Grooth[sup.7,8] , Paul W. G. Elbers[sup.7] , Pedro Povoa[sup.9,10,11] , Rui Morais[sup.11] , [...]
Background The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. Results Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract
Background The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. Results Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract