Anastasia Saade1,2, Giulia Moratelli1, Guillaume Dumas1,2, Asma Mabrouki1, Jean-Jacques Tudesq1, Lara Zafrani1,2, Elie Azoulay1,2, Michael Darmon3,4. 1. Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. 2. Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France. 3. Service de médecine Intensive et de réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. michael.darmon@aphp.fr. 4. Université de Paris, ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France. michael.darmon@aphp.fr.
Abstract
BACKGROUND: Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. METHODS: Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. RESULTS: We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18-35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8-13.9]. Incidence density of hospital-acquired infections was 125 [91-200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient's severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20-53] vs. 12% [4-20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18-52] vs. 13% [1-25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. CONCLUSIONS: In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.
BACKGROUND: Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. METHODS: Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. RESULTS: We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18-35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8-13.9]. Incidence density of hospital-acquired infections was 125 [91-200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient's severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20-53] vs. 12% [4-20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18-52] vs. 13% [1-25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. CONCLUSIONS: In this population of COVID-19patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.
Authors: Raphaela I Lau; Fen Zhang; Qin Liu; Qi Su; Francis K L Chan; Siew C Ng Journal: Nat Rev Gastroenterol Hepatol Date: 2022-10-21 Impact factor: 73.082
Authors: Jean-Baptiste Mesland; Eric Carlier; Bruno François; Nicolas Serck; Ludovic Gerard; Charlotte Briat; Michael Piagnerelli; Pierre-François Laterre Journal: Microorganisms Date: 2022-05-08
Authors: Gowri Satyanarayana; Kyle T Enriquez; Tianyi Sun; Elizabeth J Klein; Maheen Abidi; Shailesh M Advani; Joy Awosika; Ziad Bakouny; Babar Bashir; Stephanie Berg; Marilia Bernardes; Pamela C Egan; Arielle Elkrief; Lawrence E Feldman; Christopher R Friese; Shipra Goel; Cyndi Gonzalez Gomez; Keith L Grant; Elizabeth A Griffiths; Shuchi Gulati; Shilpa Gupta; Clara Hwang; Jayanshu Jain; Chinmay Jani; Anna Kaltsas; Anup Kasi; Hina Khan; Natalie Knox; Vadim S Koshkin; Daniel H Kwon; Chris Labaki; Gary H Lyman; Rana R McKay; Christopher McNair; Gayathri Nagaraj; Elizabeth S Nakasone; Ryan Nguyen; Taylor K Nonato; Adam J Olszewski; Orestis A Panagiotou; Matthew Puc; Pedram Razavi; Elizabeth V Robilotti; Miriam Santos-Dutra; Andrew L Schmidt; Dimpy P Shah; Sumit A Shah; Kendra Vieira; Lisa B Weissmann; Trisha M Wise-Draper; Ulysses Wu; Julie Tsu-Yu Wu; Toni K Choueiri; Sanjay Mishra; Jeremy L Warner; Benjamin French; Dimitrios Farmakiotis Journal: Open Forum Infect Dis Date: 2022-02-14 Impact factor: 4.423