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- Title
Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study.
- Authors
Falcone, Marco; Tiseo, Giusy; Giordano, Cesira; Leonildi, Alessandro; Menichini, Melissa; Vecchione, Alessandra; Pistello, Mauro; Guarracino, Fabio; Ghiadoni, Lorenzo; Forfori, Francesco; Barnini, Simona; Menichetti, Francesco; Group, the Pisa COVID-19 Study; Pisa COVID-19 Study Group
- Abstract
<bold>Background: </bold>Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19.<bold>Objectives: </bold>To identify predictors of superinfections in COVID-19.<bold>Methods: </bold>Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections.<bold>Results: </bold>Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11-29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5-39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4-13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2-11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7-7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1-7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P < 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445).<bold>Conclusions: </bold>The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.
- Subjects
SUPERINFECTION; COVID-19; MYCOSES; BACTERIAL diseases; LONGITUDINAL method; LENGTH of stay in hospitals
- Publication
Journal of Antimicrobial Chemotherapy (JAC), 2021, Vol 76, Issue 4, p1078
- ISSN
0305-7453
- Publication type
journal article
- DOI
10.1093/jac/dkaa530