OBJECTIVE: The aim of this retrospective study was to estimate the prevalence of healthcare-associated infections (HAI), microbiological data including resistance patterns and impact of HAI on patients' survival. METHODS: Two-centre study on 172 patients was performed. Medical records of patients hospitalized in the two COVID-19 intensive care units (ICU) localized in Bydgoszcz between 1 October 2020 and 30 March 2021 were analysed retrospectively. Data collection included demographics, microbiological, clinical variables, and patient outcome. All infections were defined according to the HAI-Net ICU protocol of the European Centre for Disease Prevention and Control (ECDC). Detailed data concerning bloodstream infection (BSI), pneumonia (PN) and urinary tract infection (UTI) were collected. RESULTS: In 97 patients (56.4%), 138 HAI cases were identified. Patients with HAI statistically more often had been administered antimicrobial therapy prior to the admission to ICU (59.8% vs. 34.7%, p < 0.05), and needed catecholamines during hospitalization (93.8% vs. 70.7%, p < 0.001). The risk of HAI increased by 50% if antimicrobial therapy had been applied before the admission to ICU, and was three times higher if during the hospitalization in ICU catecholamines infusion was needed. Mortality was higher in patients diagnosed with HAI (72.2% vs. 65.3%) but the difference was not statistically significant (p = 0.34). CONCLUSIONS: Further investigation of co-infections in critically ill patients with COVID-19 is required in order to identify HAI risk factors, define the role of empiric antimicrobial therapy and proper prevention strategies.

Anaesthesiology and Intensive Care Unit 10th Military Research Hospital and Polyclinic Bydgoszcz Poland

Department of Propaedeutics of Medicine and Infection Prevention Ludwik Rydygier Collegium Medicum Nicolaus Copernicus University Bydgoszcz Poland

Faculty of Pedagogy Kazimierz Wielki University Bydgoszcz Poland

Jan Biziel University Hospital No 2 Bydgoszcz Poland

Zobrazit více v PubMed

World Health Organization. Coronavirus Disease (COVID- 19) pandemic [Internet]. Geneva: WHO [cited 2021 Jul 4]. Available from: https://covid19.who.int/.

He Y, Li W, Wang Z, Chen T, Tian L, Liu D. Nosocomial infection among patients with COVID-19: a retrospective data analysis of 918 cases from a single center in Wuhan, China. Infect Control Hosp Epidemiol. 2020;41(8):982-3.

Giacobbe DR, Battaglini D, Ball L, Brunetti I, Bruzzone B, Codda G, et al. Bloodstream infections in critically ill patients with COVID-19. Eur J Clin Invest. 2020;50(10):e13319. doi: 10.1111/eci.13319. PubMed DOI

Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial coinfection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622-9.

Yu Y, Xu D, Fu S, Zhang J, Jang X, Xu L, et al. Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study. Crit Care. 2020;24(1):219. doi: 10.1186/s13054-020-02939-x. PubMed DOI

Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of coinfections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27(1):83-8.

Grasselli G, Scaravilli V, Mangioni D, Scudeller L, Alagna L, Bartoletti M, et al. Hospital-acquired infections in critically ill patients with COVID-19. Chest. 2021;160(2):454-65. PubMed

Dudoignon E, Caméléna F, Deniau B. Bacterial pneumonia in COVID-19 critically ill patients: a case series. Clin Infect Dis. 2020;72(5):905-6.

Bhatt PJ, Shiau S, Brunetti L, Xie Y, Solanki K, Khalid S, et al. Risk factors and outcomes of hospitalized patients with severe coronavirus disease 2019 (COVID-19) and secondary bloodstream infections: a multicenter case-control study. Clin Infect Dis. 2021;72(12):e995-1003. doi: 10.1093/cid/ciaa1748. PubMed DOI

European Centre for Disease Prevention and Control. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units. Stockholm: ECDC; 2017.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of Covid-19 in New York City. N Engl J Med. 2020;382(24):2372-4.

Baccolini V, Migliara G, Isonne C, Dorelli B, Barone LC, Giannini D, et al. The impact of the COVID-19 pandemic on healthcare-associated infections in intensive care unit patients: a retrospective cohort study. Antimicrob Resist Infect Control. 2021;10(1):87. doi: 10.1186/s13756-021-00959-y. PubMed DOI

Marin-Corral J, Pascual-Guardia S, Muñoz-Bermúdez R, Salazar-Degracia A, Climent C, Vilà-Vilardell C, et al. Health care-associated infections in patients with COVID-19 pneumonia in COVID critical care areas. Med Intensiva (Engl Ed). 2022;46(4):221-3.

Soriano MC, Vaquero C, Ortiz-Fernández A, Caballero A, Blandino-Ortiz A, de Pablo R. Low incidence of co-infection, but high incidence of ICU-acquired infections in critically ill patients with COVID-19. J Infect. 2021;82(2):e20-1. doi:10.1016/j.jinf.2020.09.010. PubMed DOI

Rafa E, Walaszek MZ, Walaszek M, Domanski A, Rozanska A. The incidence of healthcare-associated infections, their clinical forms, and microbiological agents in intensive care units in Southern Poland in a multicentre study from 2016 to 2019. Int J Environ Res Public Health. 2021;18(5):2238. doi: 10.3390/ijerph18052238. PubMed DOI

Kolpa M, Walaszek M, Gniadek A, Wolak Z, Dobros W. Incidence, microbiological profile and risk factors of healthcare associated infections in intensive care units: a 10 year observation in a provincial hospital in Southern Poland. Int J Environ Res Public Health. 2018;15(1):112. doi: 10.3390/ijerph15010112. PubMed DOI

Walaszek M, Rozanska A, Bulanda M, Wojkowska-Mach J; Team PSOHI. Epidemiology of healthcare-associated infections in Polish intensive care. A multicenter study based on active surveillance. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018;162(3):190-7. PubMed

Dubiel G, Kozlowski B, Deptula A, Hryniewicz W. Raport NPOA z Programu Czynnego Monitorowania Zakażeń w Oddziałach Anestezjologii i Intensywnej Terapii w 2018 Roku w Polsce [Internet]. Warsaw: Narodowy Program Ochrony Antybiotyków; 2020 [cited 2021 Jul 9]. Available from: http://antybiotyki.edu.pl/wp-content/uploads/2020/07/Raport-ICU-2018.pdf. (In Polish.)

Buetti N, Ruckly S, de Montmollin E, Reignier J, Terzi N, Cohen Y, et al. COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network. Intensive Care Med. 2021;47(2):180-7.

Ippolito M, Misseri G, Catalisano G, Marino C, Ingoglia G, Alessi M, et al. Ventilator-associated pneumonia in patients with COVID-19: a systematic review and meta-analysis. Antibiotics (Basel). 2021;10(5):545. doi: 10.3390/antibiotics10050545. PubMed DOI

Giacobbe DR, Battaglini D, Enrile EM, Dentone C, Vena A, Robba C, et al. Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with COVID-19: a multicenter study. J Clin Med. 2021;10(4):555. doi: 10.3390/jcm10040555. PubMed DOI

Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care. 2021 Jan 11;25(1):25. doi: 10.1186/s13054-021-03460-5. PubMed DOI

Machado M, Valerio M, Álvarez-Uría A, Olmedo M, Veintimilla C, Padilla B, et al. Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity. Mycoses. 2021;64(2):132-43. PubMed

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. PubMed

Kokkoris S, Papachatzakis I, Gavrielatou E, Ntaidou T, Ischaki E, Malachias S, et al. ICU-acquired bloodstream infections in critically ill patients with COVID-19. J Hosp Infect. 2021;107:95-7. PubMed

Lewis RE, Kontoyiannis DP. Invasive aspergillosis in glucocorticoid-treated patients. Med Mycol. 2009;47(Suppl 1):S271-81.