Secondary infection in severe and critical COVID-19 patients in China: a multicenter retrospective study.

Ling Sang,Nanshan Chen,Bin Song,Nuofu Zhang,Chang-An Li,Xuesong Liu,Yimin Li,Wei Zhang,Xiaoqing Liu,Dan Ye,Weibo Liang,Yonghao Xu,Dingyu Zhang,Nanshan Zhong,Shiyue Li,Dongdong Liu,Jiaan Xia,Li Jiang,Wenjuan Wu,Ming Zhong,Yin Xi,Xia Zheng,Sibei Chen,Yang Xu ,Ying Xian Pan ,Chun‐Hao Pan ,Zhihua Lin ,Zheng‐Tao Lv

doi:10.21037/apm-21-833

Abstract

Since 2020 COVID-19 pandemic became an emergent public sanitary incident. The epidemiology data and the impact on prognosis of secondary infection in severe and critical COVID-19 patients in China remained largely unclear. We retrospectively reviewed medical records of all adult patients with laboratory-confirmed COVID-19 who were admitted to ICUs from January 18th 2020 to April 26th 2020 at two hospitals in Wuhan, China and one hospital in Guangzhou, China. We measured the frequency of bacteria and fungi cultured from respiratory tract, blood and other body fluid specimens. The risk factors for and impact of secondary infection on clinical outcomes were also assessed. Secondary infections were very common (86.6%) when patients were admitted to ICU for >72 hours. The majority of infections were respiratory, with the most common organisms being Klebsiella pneumoniae (24.5%), Acinetobacter baumannii (21.8%), Stenotrophomonas maltophilia (9.9%), Candida albicans (6.8%), and Pseudomonas spp. (4.8%). Furthermore, the proportions of multidrug resistant (MDR) bacteria and carbapenem resistant Enterobacteriaceae (CRE) were high. We also found that age ≥60 years and mechanical ventilation ≥13 days independently increased the likelihood of secondary infection. Finally, patients with positive cultures had reduced ventilator free days in 28 days and patients with CRE and/or MDR bacteria positivity showed lower 28-day survival rate. In a retrospective cohort of severe and critical COVID-19 patients admitted to ICUs in China, the prevalence of secondary infection was high, especially with CRE and MDR bacteria, resulting in poor clinical outcomes.

Highlights

Since December 2019, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 127,619,612 laboratory-confirmed cases and 2,791,953 death cases worldwide up to March 31, 2021 [1]
The distribution of organisms isolated was quite different between Wuhan and Guangzhou; the main organisms isolated in Wuhan were K. pneumoniae and A. baumannii, while S. maltophilia and B. cepacia were more common in Guangzhou
We found that age ≥60 years and mechanical ventilation ≥13 days independently increased the likelihood of secondary infection in severe and critical COVID-19 patients

Summary

Introduction

Since December 2019, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 127,619,612 laboratory-confirmed cases and 2,791,953 death cases worldwide up to March 31, 2021 [1]. Approximately 14–26% of hospitalized COVID-19 patients have needed treatment in an intensive care unit (ICU) [2,3], and the clinical outcomes of these cases has generally been poor, with the mortality rate reaching 61.5% within 28 days [4]. Secondary infection, including those caused by bacteria and fungi, may occur during the course of respiratory viral infection. The epidemiology data and the impact on prognosis of secondary infection in severe and critical COVID-19 patients in China remained largely unclear. The majority of infections were respiratory, with the most common organisms being Klebsiella

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Results

Conclusion