Abstract
Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.
Highlights
Already in the middle of 2021, the SARS-CoV-2 infection continues, being the largest health problem worldwide [1]
This retrospective observational cohort study was performed at Hospital Puerta de Hierro-Majadahonda, a large tertiary university hospital located in Madrid, one of the most affected regions by COVID-19 during the first wave
We aimed to describe and analyze the burden and risk factors of bacterial infections in patients with COVID-9 disease, since the main therapeutic approaches to date are corticosteroids and tocilizumab, both with recognized potential to develop infections
Summary
Already in the middle of 2021, the SARS-CoV-2 infection continues, being the largest health problem worldwide [1]. The use of these immunosuppressants could increase the risk of secondary infections [6, 7]; not to forget that respiratory viral infections may predispose to bacterial [8]. Our objective was to describe and analyze the prevalence of bacterial infections and the main risk factors for infections, other than SARS-CoV-2, in patients admitted due to COVID-19 pneumonia during the first period of the pandemic. We analyzed the rate of patients with bacterial infections as well as their impact on OVID19 morbidity and mortality. Knowing the characteristics of bacterial infections in patients with COVID-19 could help us optimize therapeutic options, and corticosteroids and/or antibiotherapy use in patients at risk
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