Co-infection and ICU-acquired infection in COIVD-19 ICU patients

Detalhes bibliográficos
Autor(a) principal: Conway Morris, Andrew
Data de Publicação: 2022
Outros Autores: Kohler, Katharina, De Corte, Thomas, Ercole, Ari, De Grooth, Harm Jan, Elbers, Paul W.G., Povoa, Pedro, Morais, Rui, Koulenti, Despoina, Jog, Sameer, Nielsen, Nathan, Jubb, Alasdair, Cecconi, Maurizio, De Waele, Jan
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/143488
Resumo: Funding European Society of Intensive Care Medicine. ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1).
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spelling Co-infection and ICU-acquired infection in COIVD-19 ICU patientsa secondary analysis of the UNITE-COVID data setCritical Care and Intensive Care MedicineFunding European Society of Intensive Care Medicine. ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1).BACKGROUND: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNConway Morris, AndrewKohler, KatharinaDe Corte, ThomasErcole, AriDe Grooth, Harm JanElbers, Paul W.G.Povoa, PedroMorais, RuiKoulenti, DespoinaJog, SameerNielsen, NathanJubb, AlasdairCecconi, MaurizioDe Waele, Jan2022-09-05T22:23:07Z2022-08-032022-08-03T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article1application/pdfhttp://hdl.handle.net/10362/143488eng1364-8535PURE: 46122293https://doi.org/10.1186/s13054-022-04108-8info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T05:21:50Zoai:run.unl.pt:10362/143488Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:50:57.665693Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Co-infection and ICU-acquired infection in COIVD-19 ICU patients
a secondary analysis of the UNITE-COVID data set
title Co-infection and ICU-acquired infection in COIVD-19 ICU patients
spellingShingle Co-infection and ICU-acquired infection in COIVD-19 ICU patients
Conway Morris, Andrew
Critical Care and Intensive Care Medicine
title_short Co-infection and ICU-acquired infection in COIVD-19 ICU patients
title_full Co-infection and ICU-acquired infection in COIVD-19 ICU patients
title_fullStr Co-infection and ICU-acquired infection in COIVD-19 ICU patients
title_full_unstemmed Co-infection and ICU-acquired infection in COIVD-19 ICU patients
title_sort Co-infection and ICU-acquired infection in COIVD-19 ICU patients
author Conway Morris, Andrew
author_facet Conway Morris, Andrew
Kohler, Katharina
De Corte, Thomas
Ercole, Ari
De Grooth, Harm Jan
Elbers, Paul W.G.
Povoa, Pedro
Morais, Rui
Koulenti, Despoina
Jog, Sameer
Nielsen, Nathan
Jubb, Alasdair
Cecconi, Maurizio
De Waele, Jan
author_role author
author2 Kohler, Katharina
De Corte, Thomas
Ercole, Ari
De Grooth, Harm Jan
Elbers, Paul W.G.
Povoa, Pedro
Morais, Rui
Koulenti, Despoina
Jog, Sameer
Nielsen, Nathan
Jubb, Alasdair
Cecconi, Maurizio
De Waele, Jan
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
RUN
dc.contributor.author.fl_str_mv Conway Morris, Andrew
Kohler, Katharina
De Corte, Thomas
Ercole, Ari
De Grooth, Harm Jan
Elbers, Paul W.G.
Povoa, Pedro
Morais, Rui
Koulenti, Despoina
Jog, Sameer
Nielsen, Nathan
Jubb, Alasdair
Cecconi, Maurizio
De Waele, Jan
dc.subject.por.fl_str_mv Critical Care and Intensive Care Medicine
topic Critical Care and Intensive Care Medicine
description Funding European Society of Intensive Care Medicine. ACM is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1).
publishDate 2022
dc.date.none.fl_str_mv 2022-09-05T22:23:07Z
2022-08-03
2022-08-03T00:00:00Z
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/143488
url http://hdl.handle.net/10362/143488
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 1364-8535
PURE: 46122293
https://doi.org/10.1186/s13054-022-04108-8
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eu_rights_str_mv openAccess
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