Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS CoV‐2 infection than negative patients and are associated to a worse outcome.

De Francesco, Maria Antonia; Signorini, Liana; Piva, Simone; Pellizzeri, Simone; Fumarola, Benedetta; Corbellini, Silvia; Piccinelli, Giorgio; Simonetti, Francesca; Carta, Valentina; Mangeri, Lucia; Padovani, Michela; Vecchiati, Daniela; Latronico, Nicola; Castelli, Francesco; Caruso, Arnaldo

Patients with viral infections are at higher risk to acquire bacterial and fungal superinfections associated with a worse prognosis. We explored this critical point in the setting of patients with severe COVID‐19 disease. The study included 1911 patients admitted to intensive care unit (ICU) during a 2‐year study period (March 2020–March 2022). Of them, 713 (37.3%) were infected with SARS‐CoV‐2 and 1198 were negative (62.7%). Regression analysis was performed to determine risk factors associated with the presence of bacterial and/or fungal superinfections in SARS‐CoV‐2 patients and to evaluate predictors of ICU mortality. Of the 713 patients with SARS‐CoV‐2 infection, 473 (66.3%) had respiratory and/or bloodstream bacterial and/or fungal superinfections, while of the 1198 COVID‐19‐negative patients, only 369 (30%) showed respiratory and/or bloodstream bacterial and/or fungal superinfections (p < 0.0001). Baseline characteristics of COVID‐19 patients included a median age of 66 (interquartile range [IQR], 58–73), a predominance of males (72.7%), and the presence of a BMI higher than 24 (median 26; IQR, 24.5–30.4). Seventy‐four percent (527, 73.9%) had one or more comorbidities and 135 (18.9%) of them had received previous antibiotic therapy. Furthermore, most of them (473, 66.3%) exhibited severe radiological pictures and needed invasive mechanical ventilation. Multivariate logistic regression analysis showed that 1 unit increment in BMI rises the risk of bacterial and/or fungal superinfections acquisition by 3% and 1‐day increment in ICU stays rises the risk of bacterial and/or fungal superinfections acquisition by 11%. Furthermore, 1‐day increment in mechanical ventilation rises the risk of bacterial and/or fungal superinfection acquisition by 2.7 times. Furthermore, patients with both bacterial and fungal infections had a significantly higher mortality rate than patients without superinfections (45.8% vs. 26.2%, p < 0.0001). Therefore, bacterial and fungal superinfections are frequent in COVID‐19 patients admitted to ICU and their presence is associated with a worse outcome. This is an important consideration for targeted therapies in critically ill SARS‐CoV‐2 infected patients to improve their clinical course.

SARS-CoV-2; SUPERINFECTION; COVID-19; CRITICALLY ill; MYCOSES; KLEBSIELLA pneumoniae

Journal of Medical Virology, 2023, Vol 95, Issue 7, p1

0146-6615

Academic Journal

10.1002/jmv.28892