Prevalence and Impact of Co-infection in Critically Ill COVID-19 Patients

To determine the epidemiology and impact of co-infection on COVID-19 pneumonia in critical care setting.

This was a single center- retrospective study of COVID-19 patients, who were admitted to intensive care unit between March 2020-April 2021. Only patients with microbiological evaluation of blood, respiratory, or urine culture data were included. Community onset bacterial co-infection (COI) was defined as infection diagnosed within 48 hours and hospital acquired bacterial infection (HAI) after 48 hours of hospital admission. Both COI and HAI were further categorized into respiratory, blood or urinary sources. Demographics, laboratory and hospitalization outcomes were compared between patients with and without COI and HAI.

Among the 141 patients, COI was found in 25/132 patients (19%) and HAI in 41/109 patients (38%). COI was associated with younger age, lower body mass index (BMI) and being from nursing or long- term care facility. HAI was associated with longer length of hospital stay (29 vs 15 days). Staphylococcus aureus pneumonia (31.3%) and Pseudomonas aeruginosa pneumonia (40.0%) were the most common cause of COI and HAI respectively. Overall, gram negative bacteria predominated in both community and hospital acquired pneumonia. Candida was the single most common cause of blood stream infection in HAI (23%). The hospital survival was not significantly different with or without COI.

In the critical care setting, a significant proportion of patients with COVID-19 had COI and HAI, especially patients from nursing or long-term care facility. Antibiotic coverage for COI and HAI pneumonia should account for the increase in prevalence of Staphylococcus aureus and Pseudomonas aeruginosa respectively.