Abstract
Introduction. It is known that bacterial infections represent a common complication during viral respiratory tract infections such as influenza, with a concomitant increase in morbidity and mortality. Nevertheless, the prevalence of bacterial co-infections and secondary infections in critically ill patients affected by coronavirus disease 2019 (COVID-19) is not well understood yet. We performed a review of the literature currently available to examine the incidence of bacterial secondary infections acquired during hospital stay and the risk factors associated with multidrug resistance. Most of the studies, mainly retrospective and single-centered, highlighted that the incidence of co-infections is low, affecting about 3.5% of hospitalized patients, while the majority are hospital acquired infections, developed later, generally 10–15 days after ICU admission. The prolonged ICU hospitalization and the extensive use of broad-spectrum antimicrobial drugs during the COVID-19 outbreak might have contributed to the selection of pathogens with different profiles of resistance. Consequently, the reported incidence of MDR bacterial infections in critically ill COVID-19 patients is high, ranging between 32% to 50%. MDR infections are linked to a higher length of stay in ICU but not to a higher risk of death. The only risk factor independently associated with MDR secondary infections reported was invasive mechanical ventilation (OR 1.062; 95% CI 1.012–1.114), but also steroid therapy and prolonged length of ICU stay may play a pivotal role. The empiric antimicrobial therapy for a ventilated patient with suspected or proven bacterial co-infection at ICU admission should be prescribed judiciously and managed according to a stewardship program in order to interrupt or adjust it on the basis of culture results.
Highlights
Whether critically ill patients affected by coronavirus disease 2019 (COVID-19) are at higher risk of bacterial infections has already been a matter under discussion
Ill patients admitted with COVID-19 are at high risk of developing healthcare associated secondary infections, especially of bacterial origin, with a variable rate of resistance profiles
The incidence rate of lower respiratory tract infections was interestingly higher when compared to those related to non-COVID-19 critically ill patients, mainly due to a pathophysiological mechanism mediated by the viral infection
Summary
Whether critically ill patients affected by coronavirus disease 2019 (COVID-19) are at higher risk of bacterial infections has already been a matter under discussion. The coexistence of viral and bacterial infections at admission is usually associated with greater severity of illness and increased risk of death [4]. Both the severity of the respiratory disease in patients affected by COVID-19 at ICU admission and the difficulty of ruling out a bacterial co-infection on presentation lead to a wide prescription of broad-spectrum antimicrobial drugs. The extensive introduction of empiric antimicrobial therapy was endorsed by the Surviving Sepsis Campaign guidelines, which suggested the use of empiric antimicrobial treatment over no treatment at ICU admission
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