PREDICTORS AND OUTCOMES OF BACTERIAL AND FUNGAL SUPERINFECTIONS IN CRITICALLY ILL PATIENTS WITH COVID-19

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Secondary infections are well-described complications in patients with viral pneumonia and are associated with increased mortality and morbidity (1). A recent meta-analysis reported that secondary infections in critically ill Coronavirus Disease 19 (COVID-19) patients in intensive care unit (ICU) are around 14% (2). Most of the studies are limited by false-positive cultures in non-sterile body fluids (2). Our study aims to assess the burden of secondary infections by focusing on the positive rate of sterile body fluid cultures in ICU patients, to examine associated risk factors and to assess their impact on outcome. METHODS: Retrospective analysis of all adult patients with COVID-related acute respiratory distress syndrome (ARDS) admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 05/31/2020. Patients who had positive sterile body fluid (blood, peritoneal, pleural or cerebrospinal fluid) cultures for bacteria or fungi, were compared with those without positive cultures. RESULTS: Of the 210 patients admitted to our ICU with COVID-19 related ARDS, 55 patients (26%) had positive sterile body fluid cultures, of which 37 grew bacteria, 7 fungi and 11 both. Patients with positive cultures were similar in terms of baseline demographics, comorbidities and severity of illness at ICU admission to those patients without positive cultures. Peak inflammatory markers were significantly higher in the positive culture group. In the positive culture group, the rates of receipt of steroids (78% vs. 61%, p=0.02) and convalescent plasma (64% vs. 45%, p=0.03) were significantly higher. The prevalence of acute kidney injury (AKI) requiring dialysis was significantly greater in the positive culture group (55% vs. 28%, p<0.001). There was no difference in terms of mortality between the two groups. However, mechanical ventilation (MV) free days at day 28 were significantly lower in the positive culture group (Mean ± S.D: 2.7 ± 5.7 vs. 6 ± 9.9, p=0.004). CONCLUSIONS: Our study shows that the incidence of superinfections in COVID-19 patients admitted to ICUs is higher than previously reported. The higher incidence is comparable to the rate of superinfections in the H1N1 influenza pandemic of 2009 (2). However, the high rates of steroid and plasma administration in our positive culture group may also have contributed to the high incidence of secondary infections. Our results have also shown that these infections may prolong ventilatory support as well as increase the likelihood of developing AKI requiring dialysis. Therefore, intensivists need to be vigilant about not missing superinfections in patients with COVID-19 which can negatively impact patient outcomes. CLINICAL IMPLICATIONS: This study will help to identify the risk factors associated with higher incidence of secondary infections in patients with COVID-19, and will assist physicians to identify and treat them early in the course of disease. 1. I. Martin-Loeches, A. Sanchez-Corral, E. Diaz, R.M. Granada, et al., H1N1 SEMICYUC Working Group Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus. Chest, 139 (2011), pp. 555-562. 2. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266-275. DISCLOSURES: No relevant relationships by ALEENA ARSHAD, source=Web Response No relevant relationships by Dipak Chandy, source=Web Response No relevant relationships by Oleg Epelbaum, source=Web Response No relevant relationships by Daniel Greenberg, source=Web Response No relevant relationships by Muhammad Rizwan, source=Web Response No relevant relationships by Hamid Yaqoob, source=Web Response