Open AccessNosocomial Infection in Patients with Severe and Critical COVID-19
Author(s) -
Mikhail V. Bychinin,
I. O. Antonov,
Т. В. Клыпа,
Irina A. Mandel,
Andrey I. Minets,
Nadezhda A. Kolyshkina,
Ya. B. Golobokova
Publication year - 2022
Publication title -
obŝaâ reanimatologiâ
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.175
H-Index - 6
eISSN - 2411-7110
pISSN - 1813-9779
DOI - 10.15360/1813-9779-2022-1-4-10
Subject(s) - medicine , pneumonia , intensive care unit , mechanical ventilation , acinetobacter baumannii , renal replacement therapy , etiology , sepsis , gastroenterology , urinary system , pseudomonas aeruginosa , biology , bacteria , genetics
The aim of the study was to determine the etiology and frequency of nosocomial infections in patients with severe and critical COVID-19. Material and methods. A retrospective, single-center study included 168 patients with COVID-19 admitted to the intensive care unit (ICU). All episodes of infection, clinical and laboratory characteristics, and outcome were documented in patients. Results . Hospital-acquired infections were detected in 82 (48.8%) of 168 patients, more frequently in men ( p = 0.028). A total of 232 episodes of nosocomial infections were observed including ventilator-associated pneumonia (48.2%), bloodstream infection (39.2%), nosocomial pneumonia/tracheobronchitis (13.4%), and urinary tract infection (5.2%). The main causative agents of nosocomial infections were resistant strains of Acinetobacter baumannii and Klebsiella pneumoniae . Infections developed on the average on day 6 [3; 9] of ICU stay and were associated with the initial severity of the patients assessed by SOFA ( p =0.016), SpO 2 ( p =0.005), lymphopenia severity ( p =0.003), Neutrophil-Lymphocyte Ratio ( p =0.004), C-reactive protein ( p =0.01), aspartate aminotransferase (AST) level ( p =0.022), or vitamin D ( p =0.035) levels. Patients diagnosed with infection were more likely than those without infections to require mechanical ventilation (67.6% vs 32.4%, p < 0.001), high-flow oxygen therapy (50.0% vs 31.0%, p = 0.020), renal replacement therapy (36.8% vs 9.3%, p = 0.003), and had longer ICU length of stay (13 [9; 18] vs 4 [2; 8], p < 0.001), hospital length of stay (19 [14; 29] vs 15 [11; 20], p = 0.001) and mortality (47 (57.3%) vs 25 (29.0%), p < 0.001). Conclusion. In patients with severe and critical COVID-19 a high incidence of nosocomial infections was found, which negatively affected the outcome. In more than half of the cases, the infection was caused by resistant strains of Gram-negative bacilli. Procalcitonin is a useful biomarker for identifying bacterial infection in patients with COVID-19.