Health care-associated infections in patients with COVID-19 pneumonia in COVID critical care areas

Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients

BACKGROUND

Healthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients.

METHODS

The study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases.

RESULTS

The study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084-4.806), p < 0.001.

CONCLUSIONS

Patients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.

Effect of the duration of prone position in ARDS patients during the SARS-CoV-2 pandemic

OBJECTIVE

To describe the characteristics of patients with acute respiratory distress syndrome (ARDS) due to bilateral COVID-19 pneumonia on invasive mechanical ventilation (IMV), and to analyze the effect of prone position >24 h (prolonged) (PPP) compared to prone decubitus <24 h (PP).

DESIGN

A retrospective observational descriptive study was carried out, with uni- and bivariate analyses.

SETTING

Department of Intensive Care Medicine. Hospital General Universitario de Elche (Elche, Alicante, Spain).

PARTICIPANTS

Patients with SARS-CoV-2 pneumonia (2020-2021) on IMV due to moderate-severe ARDS, ventilated in prone position (PP).

INTERVENTIONS

IMV. PP maneuvers.

MAIN VARIABLES OF INTEREST

Sociodemographic characteristics, analgo-sedation, neuromuscular blockade (NMB), PD duration, ICU stay and mortality, days of IMV, non-infectious complications, healthcare associated infections.

RESULTS

Fifty-one patients required PP, and of these, 31 (69.78%) required PPP. No differences were observed in terms of patient characteristics (gender, age, comorbidities, initial severity, antiviral and antiinflammatory treatment received). Patients on PPP had poorer tolerance to supine ventilation (61.29% vs 89.47%, p = 0.031), longer hospital stay (41 vs 30 days, p = 0.023), more days of IMV (32 vs 20 days, p = 0.032), longer duration of NMB (10.5 vs 3 days, p = 0.0002), as well as a higher percentage of episodes of orotracheal tube obstruction (48.39% vs 15%, p = 0.014).

CONCLUSIONS

PPP was associated with greater resource use and complications in patients with moderate-severe ARDS due to COVID-19.

Effect of the Pandemic Outbreak on ICU-Associated Infections and Antibiotic Prescription Trends in Non-COVID19 Acute Respiratory Failure Patients

BACKGROUND

The COVID-19 pandemic had a relevant impact on the organization of intensive care units (ICU) and may have reduced the overall compliance with healthcare-associated infections (HAIs) prevention programs. Invasively ventilated patients are at high risk of ICU-associated infection, but there is little evidence regarding the impact of the pandemic on their occurrence in non-COVID-19 patients. Moreover, little is known of antibiotic prescription trends in the ICU during the first wave of the pandemic. The purpose of this investigation is to assess the incidence, characteristics, and risk factors for ICU-associated HAIs in a population of invasively ventilated patients affected by non-COVID-19 acute respiratory failure (ARF) admitted to the ICU in the first wave of the COVID-19 pandemic, and to evaluate the ICU antimicrobial prescription strategies. Moreover, we compared HAIs and antibiotic use to a cohort of ARF patients admitted to the ICU the year before the pandemic during the same period.

METHODS

this is a retrospective, single-centered cohort study conducted at S. Anna University Hospital (Ferrara, Italy). We enrolled patients admitted to the ICU for acute respiratory failure requiring invasive mechanical ventilation (MV) between February and April 2020 (intra-pandemic group, IP) and February and April 2019 (before the pandemic group, PP). We excluded patients admitted to the ICU for COVID-19 pneumonia. We recorded patients' baseline characteristics, ICU-associated procedures and devices. Moreover, we evaluated antimicrobial therapy and classified it as prophylactic, empirical or target therapy, according to the evidence of infection at the time of prescription and to the presence of a positive culture sample. We compared the results of the two groups (PP and IP) to assess differences between the two years.

RESULTS

One hundred and twenty-eight patients were screened for inclusion and 83 patients were analyzed, 45 and 38 in the PP and I group, respectively. We found a comparable incidence of HAIs (62.2% vs. 65.8%, p = 0.74) and multidrug-resistant (MDR) isolations (44.4% vs. 36.8% p= 0.48) in the two groups. The year of ICU admission was not independently associated with an increased risk of developing HAIs (OR = 0.35, 95% CI 0.16-1.92, p = 0.55). The approach to antimicrobial therapy was characterized by a significant reduction in total antimicrobial use (21.4 ± 18.7 vs. 11.6 ± 9.4 days, p = 0.003), especially of target therapy, in the IP group.

CONCLUSIONS

ICU admission for non-COVID-19 ARF during the first wave of the SARS-CoV-2 pandemic was not associated with an increased risk of ICU-associated HAIs. Nevertheless, ICU prescription of antimicrobial therapy changed and significantly decreased during the pandemic.

["Infections related to invasive devices in COVID-19 patients admitted to critical care units"]

Introducción

Los pacientes COVID-19 ingresados en unidades de críticos presentan una intensa respuesta inflamatoria y la necesidad de sustitución de órganos o sistemas durante largos periodos de tiempo lo que facilita la presencia de complicaciones infecciosas.

Objetivos

Presentar las tasas nacionales de infecciones relacionadas con dispositivos invasivos (IRDI) en los pacientes COVID-19, así como las tasas de bacterias multirresistentes (BMR) adquiridas durante su estancia en las unidades de críticos.

Método

Análisis retrospectivo de los pacientes COVID-19 incluidos durante la primera, segunda y cuarta ola de pandemia en una base de datos (ENVIN-HELICS), observacional y multicéntrica, de ámbito nacional. Se registraron las neumonías relacionadas con ventilación mecánica (N-VM), infecciones del tracto urinario relacionadas con sonda uretral (ITU-SU) y bacteriemias primarias relacionas con catéteres venoso central (BP-CVC) cuyas tasas se presentan como densidad de incidencia (DI). Se registraron las BMR adquiridas durante la estancia en las unidades de críticos que se presentan como incidencia acumulada (IA).

Resultados

Se incluyeron 7.778 pacientes, 1.525 (19,6%) en la primera ola de la pandemia, 3.484 (44,8%) en la segunda y 2.769 (35,6%) en la cuarta. Estancia en la UCI de 21 días en la primera y segunda ola y de 19,7 días en la cuarta. Mortalidad intra-UCI en la primera ola, del 31% disminuyendo al 26,3% en la segunda y del 18,9% en la cuarta. Tasas de N-VM de 14,31, 13,56 y 19,99 episodios por 1.000 días de VM en cada ola. Tasas de ITU-SU de 6,54, 5,63 y 7,97 episodios por 1.000 días de SU. Tasas de BP-CVC de 12,42, 7,95 y 8,13 por 1.000 días de CVC. La tasa de BMR fue de 22,9, 15,3 y 15,3 BMR por 100 pacientes ingresados.

Conclusiones

Elevadas tasas de las diferentes IRDI en los pacientes COVID que se mantienen en las 3 olas analizadas. Elevadas tasas de BMR adquiridas durante la estancia en las unidades de críticos con tendencia a disminuir en la cuarta ola.

Co-infections in COVID-19 patients and correlation with mortality rate. Minireview

PURPOSE

The goal of our review was to gather information on the most important community-acquired and hospital-acquired co-infections among coronavirus disease 2019 (COVID-19) patients, and to examine not only the effect of these co-infections on disease outcomes but also to identify the possible risk factors that predispose COVID-19 patients to co-infections.

METHODS

Medline (PubMed) and Google Scholar were searched for relevant articles published between January 1st, 2020, and September 31st, 2021, on the topic of co-infections among COVID-19 patients.

RESULTS

Among community-acquired and hospital-acquired co-infections, bacterial and fungal co-infections are equally frequent, followed by viral co-infections that affected a relatively smaller portion of patients. Overall, co-infections were more frequent in the hospital than at the community level. Risk factors for acquiring co-infections include male gender, longer length of hospital stay, presence of supportive treatment, such as ventilation, the admission to intensive care units, the administration of medications, such as steroids or antibiotics, and certain blood parameters, such as high C-reactive protein or lymphopenia. The presence of co-infections could aggravate the COVID-19 disease severity, prolong the healing time of patients, and lead to worse disease outcomes overall.

CONCLUSION

Co-infections may increase the mortality of COVID-19 patients, especially in the hospital setting. Paying closer attention to hygiene, adhering to diagnostic and therapeutic protocols, implementing antimicrobial stewardship programs could decrease the occurrence of co-infections and lead to improved outcomes for COVID-19 patients.