1
|
Li P, Li Y, Zhang Y, Zhu S, Pei Y, Zhang Q, Liu J, Bao J, Sun M. A dynamic nomogram to predict invasive fungal super-infection during healthcare-associated bacterial infection in intensive care unit patients: an ambispective cohort study in China. Front Cell Infect Microbiol 2024; 14:1281759. [PMID: 38469345 PMCID: PMC10925706 DOI: 10.3389/fcimb.2024.1281759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/08/2024] [Indexed: 03/13/2024] Open
Abstract
Objectives Invasive fungal super-infection (IFSI) is an added diagnostic and therapeutic dilemma. We aimed to develop and assess a nomogram of IFSI in patients with healthcare-associated bacterial infection (HABI). Methods An ambispective cohort study was conducted in ICU patients with HABI from a tertiary hospital of China. Predictors of IFSI were selected by both the least absolute shrinkage and selection operator (LASSO) method and the two-way stepwise method. The predictive performance of two models built by logistic regression was internal-validated and compared. Then external validity was assessed and a web-based nomogram was deployed. Results Between Jan 1, 2019 and June 30, 2023, 12,305 patients with HABI were screened in 14 ICUs, of whom 372 (3.0%) developed IFSI. Among the fungal strains causing IFSI, the most common was C.albicans (34.7%) with a decreasing proportion, followed by C.tropicalis (30.9%), A.fumigatus (13.9%) and C.glabrata (10.1%) with increasing proportions year by year. Compared with LASSO-model that included five predictors (combination of priority antimicrobials, immunosuppressant, MDRO, aCCI and S.aureus), the discriminability of stepwise-model was improved by 6.8% after adding two more predictors of COVID-19 and microbiological test before antibiotics use (P<0.01).And the stepwise-model showed similar discriminability in the derivation (the area under curve, AUC=0.87) and external validation cohorts (AUC=0.84, P=0.46). No significant gaps existed between the proportion of actual diagnosed IFSI and the frequency of IFSI predicted by both two models in derivation cohort and by stepwise-model in external validation cohort (P=0.16, 0.30 and 0.35, respectively). Conclusion The incidence of IFSI in ICU patients with HABI appeared to be a temporal rising, and our externally validated nomogram will facilitate the development of targeted and timely prevention and control measures based on specific risks of IFSI.
Collapse
Affiliation(s)
- Peng Li
- Department of Infection Control, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Li
- Department of Infection Control, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Youjian Zhang
- Department of Infection Control, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Shichao Zhu
- Central Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongju Pei
- Respiratory Intensive Care Unit, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Zhang
- Department of Clinical Microbiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Junping Liu
- Department of Infectious Disease, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Mingjie Sun
- Department of Infection Control, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
2
|
Andersen HV, Jørgensen VRL, Steensen M, Pedersen FM, Helleberg M. Superinfections in COVID-19 patients receiving extracorporeal membrane oxygenation support. Acta Anaesthesiol Scand 2023; 67:755-761. [PMID: 36906734 DOI: 10.1111/aas.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND The risk of superinfections and associations with mortality among patients with corona virus disease 2019 (COVID-19) receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) is poorly elucidated. METHOD We identified all patients with COVID-19 treated with VV-ECMO >24 h at Rigshospitalet, Denmark from March 2020 to December 2021. Data were obtained by review of medical files. Associations between superinfections and mortality were assessed by logistic regression analyses adjusted for sex and age. RESULTS Fifty patients, median age 53 years (interquartile range [IQR] 45-59), 66% male, were included. Median time on VV-ECMO was 14.5 days (IQR 6.3-23.5), 42% were discharged from hospital alive. Bacteremia, ventilator associated pneumonia (VAP), invasive candidiasis, pulmonary aspergillosis, herpes simplex virus, and cytomegalovirus (CMV) were detected in 38%, 42%, 12%, 12%, 14%, and 20% of patients, respectively. No patients with pulmonary aspergillosis survived. CMV was associated with increased risk of death, odds ratio 12.6 (95% confidence interval 1.9-257, p = .05), whereas we found no associations between other superinfections and risk of death. CONCLUSION Bacteremia and VAP are common but does not seem to affect mortality, whereas pulmonary aspergillosis and CMV are associated with poor prognosis among COVID-19 patients treated with VV-ECMO.
Collapse
Affiliation(s)
| | - Vibeke R L Jørgensen
- Department of Thoracic Anesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Morten Steensen
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Finn M Pedersen
- Department of Thoracic Anesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marie Helleberg
- CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
After SARS-CoV-2 Pandemics: New Insights into ICU-Acquired Pneumonia. J Clin Med 2023; 12:jcm12062160. [PMID: 36983162 PMCID: PMC10059993 DOI: 10.3390/jcm12062160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
SARS-CoV-2 pandemics profoundly modified the process of hospital care [...]
Collapse
|
4
|
Hu S, You Y, Zhang S, Tang J, Chen C, Wen W, Wang C, Cheng Y, Zhou M, Feng Z, Tan T, Qi G, Wang M, Liu X. Multidrug-resistant infection in COVID-19 patients: A meta-analysis. J Infect 2023; 86:66-117. [PMID: 36347426 PMCID: PMC9637013 DOI: 10.1016/j.jinf.2022.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Siqi Hu
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Yao You
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Shenghui Zhang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Jiake Tang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Chen Chen
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Wen Wen
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Chunyi Wang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China
| | - Yongran Cheng
- School of Public Health, Hangzhou Medical College, Hangzhou, 311300, China
| | - Mengyun Zhou
- Department of Molecular & Cellular Physiology, Shinshu University School of Medicine, 3900803, Japan
| | - Zhanhui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, 550000, China
| | - Tao Tan
- Faculty of Applied Science, Macao Polytechnic University, Macao SAR, 999078, China
| | - Guanming Qi
- Division of Pulmonary, Critical Care and Sleep, Tufts Medical Center, Boston, MA, 02111, USA,Corresponding authors
| | - Mingwei Wang
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China,Corresponding authors
| | - Xiaoyan Liu
- Hangzhou Institute of Cardiovascular Diseases, Affiliated Hospital of Hangzhou Normal University, Hangzhou Normal University,Hangzhou, 310015, China,Corresponding authors
| |
Collapse
|
5
|
Sysiak-Sławecka J, Wichowska O, Piwowarczyk P, Borys M. The impact of bacterial superinfections on the outcome of critically ill patients with COVID-19 associated acute respiratory distress syndrome (ARDS) - a single-centre, observational cohort study. Anaesthesiol Intensive Ther 2023; 55:163-167. [PMID: 37728443 PMCID: PMC10496093 DOI: 10.5114/ait.2023.130833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Bacterial superinfections are common in severely ill COVID-19 patients and could be associated with a significant increase in morbidity and mortality. MATERIAL AND METHODS We assessed 29 critically ill patients treated in a university hospital's intensive care unit (ICU). Each patient required mechanical ventilation due to COVID-19-induced acute respiratory distress syndrome (ARDS). Fifteen patients who required venovenous extracorporeal membrane oxygenation (VV-ECMO) support (ECMO group) were compared to a control group (CON group) of 14 individuals without ECMO. This study aimed to assess the prevalence of superinfection in both studied groups. Moreover, we evaluated mortality, length of stay in the ICU, positive culture results, antibiotics used during treatment, and the impact of immunomodulatory drugs on secondary infections. RESULTS We did not find a difference in the number of superinfections between the ECMO and CON groups (11 vs. 10, P = 1.0). The mortality rate was 67% in the ECMO group and 64% in the CON group ( P = 1.0). The patients in both groups had similar numbers of positive culture results and days in the ICU prior to the detection of a positive culture. Antibiotics were administered to ten patients in the ECMO and eight patients in the CON group. The mortality rate was 81% in patients with superinfection versus 25% in those without co-infection ( P = 0.009). We found a negative impact of urea concentration on mortality in our cohort, with an odds ratio of 0.942 (0.891-0.996, P = 0.034). CONCLUSIONS Our results suggest that bacterial superinfection in COVID-19 patients negatively impacted survival in the ICU. VV-ECMO support in COVID-19 patients does not seem to improve the outcomes of patients with severe ARDS.
Collapse
Affiliation(s)
- Justyna Sysiak-Sławecka
- II Department of Anaesthesiology and Intensive Care Medicine, Medical University of Lublin, Lublin, Poland
| | | | | | | |
Collapse
|
6
|
Mustafa ZU, Tariq S, Iftikhar Z, Meyer JC, Salman M, Mallhi TH, Khan YH, Godman B, Seaton RA. Predictors and Outcomes of Healthcare-Associated Infections among Patients with COVID-19 Admitted to Intensive Care Units in Punjab, Pakistan; Findings and Implications. Antibiotics (Basel) 2022; 11:antibiotics11121806. [PMID: 36551463 PMCID: PMC9774163 DOI: 10.3390/antibiotics11121806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Healthcare-associated infections (HAIs) have a considerable impact on morbidity, mortality and costs. The COVID-19 pandemic resulted in an appreciable number of hospitalized patients being admitted to intensive care units (ICUs) globally with a greater risk of HAIs. Consequently, there is a need to evaluate predictors and outcomes of HAIs among COVID-19 patients admitted to ICUs. A retrospective study of patients with COVID-19 admitted to ICUs of three tertiary care hospitals in the Punjab province over a five-month period in 2021 was undertaken to ascertain predictors and outcomes of HAIs. Of the 4534 hospitalized COVID-19 patients, 678 were admitted to ICUs, of which 636 patients fulfilled the inclusion criteria. Overall, 67 HAIs were identified among the admitted patients. Ventilator-associated lower respiratory tract infections and catheter-related urinary tract infections were the most frequent HAIs. A significantly higher number of patients who developed HAIs were on anticoagulants (p = 0.003), antithrombotic agents (p < 0.001), antivirals (p < 0.001) and IL-6 inhibiting agents (p < 0.001). Secondary infections were significantly higher in patients who were on invasive mechanical ventilation (p < 0.001), had central venous access (p = 0.023), and urinary catheters (p < 0.001). The mortality rate was significantly higher in those with secondary infections (25.8% vs. 1.2%, p < 0.001). Our study concluded that COVID-19 patients admitted to ICUs have a high prevalence of HAIs associated with greater mortality. Key factors need to be addressed to reduce HAIs.
Collapse
Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Pinang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan
- Correspondence: (Z.U.M.); (B.G.)
| | - Sania Tariq
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Pakistan
| | - Zobia Iftikhar
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Pakistan
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Correspondence: (Z.U.M.); (B.G.)
| | - R. Andrew Seaton
- Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
- Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow G1 2NP, UK
| |
Collapse
|
7
|
Bruni A, Longhini F, Macheda S, Biamonte E, Pasqua P, Neri G, Guzzo ML, Garofalo E. Characteristics of unvaccinated and vaccinated critically ill COVID-19 patients in calabria region (Italy): A retrospective study. Front Med (Lausanne) 2022; 9:1042411. [PMID: 36507545 PMCID: PMC9729689 DOI: 10.3389/fmed.2022.1042411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction After the rapid surge of a novel coronavirus (SARS-CoV-2) in 2020 anti-SARS-CoV-2 vaccines have been developed to prevent the development of critical forms of COVID-19 leading to Intensive Care Unit (ICU) admission. The possibility of ICU admission after the first-cycle vaccination has been already reported; however, no data have been published regarding vaccinated patients with a "booster" dose. This retrospective study describes the characteristics of critically ill patients after the implementation of the regional "booster" dose vaccination program in a southern region of Italy. Materials and methods We screened all medical records of critically ill COVID-19 patients in the period between January to April 2022. We collected the demographic characteristics, the presence of comorbidities, the vaccination status, the clinical course (arterial blood gases and type of respiratory support) and outcomes (rate of tracheostomy, ICU length of stay and mortality). Results A total of 272 patients were admitted to ICUs during the study period. 161 patients were unvaccinated, whereas 111 were vaccinated with the complete first-cycle or "booster" dose. The type of respiratory support was similar between groups. Vaccinated patients were characterized by a better oxygenation throughout the whole ICU length of stay. Fourteen unvaccinated and 3 vaccinated patients required tracheostomy (p = 0.045). ICU length of stay was 12.2 (± 7.3) days in unvaccinated patients and 10.4 (± 6.7) days in vaccinated patients (p = 0.036). ICU mortalities were 38.5 and 24.3% in unvaccinated and vaccinated patients, respectively (p = 0.014). Conclusion Vaccinated patients have better clinical course and outcomes as compared to the unvaccinated population.
Collapse
Affiliation(s)
- Andrea Bruni
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy,*Correspondence: Andrea Bruni,
| | - Federico Longhini
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy,Federico Longhini,
| | - Sebastiano Macheda
- Anesthesia and Intensive Care Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Eugenio Biamonte
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Pino Pasqua
- Anesthesia and Intensive Care Unit, Annunziata Hospital, Cosenza, Italy
| | - Giuseppe Neri
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Maria Laura Guzzo
- Anesthesia and Intensive Care Unit, Hospital Pugliese Ciaccio, Catanzaro, Italy
| | - Eugenio Garofalo
- Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | |
Collapse
|