Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Conway Morris, A.; Kohler, K.; De Corte, T.; Ercole, A.; De Grooth, H. -J.; Elbers, P. W. G.; Povoa, P.; Morais, R.; Koulenti, D.; Jog, S.; Nielsen, N.; Jubb, A.; Cecconi, M.; De Waele, J.; Bezzi, M.; Gira, A.; Eller, P.; Hamid, T.; Haque, I. U.; De Buyser, W.; Cudia, A.; De Backer, D.; Foulon, P.; Collin, V.; Van Hecke, J.; De Waele, E.; Van Malderen, C.; Mesland, J. -B.; Piagnerelli, M.; Haentjens, L.; De Schryver, N.; Van Leemput, J.; Vanhove, P.; Bulpa, P.; Ilieva, V.; Katz, D.; Geagea, A.; Binnie, A.; Tirapegui, F.; Lago, G.; Graf, J.; Perez-Araos, R.; Vargas, P.; Martinez, F.; Labarca, E.; Franco, D. M.; Parra-Tanoux, D.; Reyes, L. F.; Yepes, D.; Periš, F.; Stipic, S. S.; Burgos, C. V. C.; Boada, P. R. N.; Brun, J. L. B.; Ballesteros, J. P. P.; Hammouda, A.; Elmandouh, O.; Azzam, A.; Hussein, A. M.; Galal, I.; Awad, A. K.; Azab, M. A.; Abdalla, M.; Assal, H.; Alfishawy, M.; Ghozy, S.; Tharwat, S.; Eldaly, A.; Reinhard, V.; Chrisment, A.; Poyat, C.; Badie, J.; Ferrari, F. B.; Weiss, B.; Kuhn, K. F.; Grunow, J. J.; Lorenz, M.; Schaller, S.; Spieth, P.; Bota, M.; Fichtner, F.; Fuest, K.; Lahmer, T.; Herrmann, J.; Meybohm, P.; Markou, N.; Vasileiadou, G.; Chrysanthopoulou, E.; Papamichalis, P.; Soultati, I.; Kalvit, K.; Myatra, S. N.; Krupa, I.; Tharwat, A.; Nichol, A.; Mccarthy, A.; Mahmoodpoor, A.; Tonetti, T.; Isoni, P.; Spadaro, S.; Volta, C. A.; Mirabella, L.; Noto, A.; Florio, G.; Guzzardella, A.; Paleari, C.; Baccanelli, F.; Savi, M.; Antonelli, M.; Vaccarini, B.; Montrucchio, G.; Sales, G.; Donadello, K.; Gottin, L.; Polati, E.; De Rosa, S.; Sulemanji, D.; Abusalama, A.; Elhadi, M.; De Jesus, M. F.; Gonzalez, D. R.; Canedo, N.; Chavez, A. E.; Dendane, T.; Grady, B.; de Jong, B.; van der Heiden, E.; Thoral, P.; van den Bogaard, B.; Spronk, P. E.; Achterberg, S.; Groeneveld, M.; R. K. L., So; de Wijs, C.; Scholten, H.; Beishuizen, A.; Cornet, A. D.; Reidinga, A. C.; Kranen, H.; Mensink, R.; Boer, S.; de Groot, M.; Beck, O.; Bethlehem, C.; van Bussel, B.; Frenzel, T.; de Jong, C.; Wilting, R.; Kesecioglu, J.; Mehagnoul-Schipper, J.; Alasia, D.; Kumar, A.; Qayyum, A.; Rana, M.; Jayyab, M. A.; Sierra, R. Q.; Hernandez, A. M.; Taborda, L.; Ramires, T.; Silva, C.; Roriz, C.; Patricio, P.; Santos, M. L.; Costa, V.; Cunha, P.; Gonçalves, C.; Nunes, S.; Camões, J.; Adrião, D.; Oliveira, A.; Omrani, A.; Al Maslamani, M.; Elbuzidi, A. S.; Al qudah, B. M.; Akkari, A. R.; Alkhatteb, M.; Baiou, A.; Husain, A.; Alwraidat, M.; Saif, I. A.; Bakdach, D.; Ahmed, A.; Aleef, M.; Bintaher, A.; Petrisor, C.; Popov, E.; Popova, K.; Dementienko, M.; Teplykh, B.; Pyregov, A.; Davydova, L.; Vladislav, B.; Neporada, E.; Zverev, I.; Meshchaninova, S.; Sokolov, D.; Gavrilova, E.; Shlyk, I.; Poliakov, I.; B?aco?a, M.; Aljuhani, O.; Alkhalaf, A.; Humaid, F. B.; Arabi, Y.; Kuhail, A.; Elrabi, O.; Alghnam, M.; Kansal, A.; V. K., Ho; Ng, J.; García, R. R.; Fraga, X. T.; del Pilar García-Bonillo, M.; Padilla-Serrano, A.; Cuadrado, M. M.; Ferrando, C.; Catalan-Monzon, I.; Galarza, L.; Frutos-Vivar, F.; Jimenez, J.; Rodríguez-Solis, C.; Franquesa-Gonzalez, E.; Acosta, G. P.; Cabrera, L. S.; Parra, J. P. A.; Gonzalez, F. M.; del Carmen Lorente Conesa, M.; Varela, I. Y. M.; Pravia, O. V. B.; Delgado, M. C. M.; de Cabo, C. M.; Ioan, A. -M.; Perez-Calvo, C.; Santos, A.; Abad-Motos, A.; Ripolles-Melchor, J.; Martin, B. C.; Teruel, S. Y.; Lucas, J. H.; Ortiz, A. B.; de Pablo Sánchez, R.; Barrueco-Francioni, J. E.; Espina, L. F.; Bonell-Goytisolo, J. M.; Salaverria, I.; Mir, A. S.; Rodriguez-Ruiz, E.; Valverde, V. H.; Cubero, P. J.; Linde, F. A.; Leganes, N. C.; Romeu, J. M.; Concha, P.; Berezo-Garcia, J. A.; Fraile, V.; Cuenca-Rubio, C.; Perez-Torres, D.; Serrano, A.; Valero, C. M.; Suner, A. O.; Larrañaga, L.; Legaristi, N.; Ferrigno, G.; Khlafalla, S.; Bihariesingh-Sanchit, R.; Zoerner, F.; Grip, J.; Kilsand, K.; Österlind, J.; von Seth, M.; Berkius, J.; Ceruti, S.; Glotta, A.; Izdes, S.; Turan, I. Ö.; Cosar, A.; Halacli, B.; Dereli, N.; Yilmaz, M.; Akbas, T.; Elay, G.; Eyüpoglu, S.; Bílír, Y.; Saraçoglu, K. T.; Kaya, E.; Sahin, A. S.; Ekren, P. K.; Mengi, T.; Suner, K. O.; Tomak, Y.; Eroglu, A.; Alsabbah, A.; Hanlon, K.; Gervin, K.; Mcmahon, S.; Hagan, S.; Higenbottam, C. V.; Mullhi, R.; Poulton, L.; Torlinski, T.; Gareth, A.; Truman, N.; Vijayakumar, G.; Hall, C.; Cagova, L.; Jones, N.; Graham, S.; Robin, N.; Cowton, A.; Donnelly, A.; Singatullina, N.; Kent, M.; Boulanger, C.; Campbell, Z.; Potter, E.; Duric, N.; Szakmany, T.; Kviatkovske, O.; Marczin, N.; Ellis, C.; Saha, R.; Sri-Chandana, C.; Allan, J.; Mumelj, L.; Venkatesh, H.; Gotz, V. N.; Cochrane, A.; Lumlertgul, N.; Ficial, B.; Jain, S.; Crapelli, G. B.; Vlachou, A.; Golden, D.; Garrioch, S.; Henning, J.; Loveleena, G.; Davey, M.; Grauslyte, L.; Salciute-Simene, E.; Cook, M.; Barling, D.; Broadhurst, P.; Purvis, S.; Michael, S.; Shuker, B.; Grecu, I.; Harding, D.; Dean, J. T.; Al-Bayati, S.; Al-Sadawi, M.; Charron, M.; Stubenrauch, P.; Santanilla, J.; Wentowski, C.; Rosenberger, D.; Eksarko, P.; Jawa, R.

doi:10.1186/s13054-022-04108-8

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.