[en] [en] BACKGROUND: Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients.
PATIENTS AND METHODS: We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching.
RESULTS: Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05-1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population.
CONCLUSION: COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Massart, Nicolas; Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France
Maxime, Virginie; Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France
Fillatre, Pierre; Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France
Razazi, Keyvan; AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France ; Univ Paris Est Créteil, INSERM, IMRB, 94010, Créteil, France ; Université Paris Est Créteil, Faculté de Médecine de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France
Ferré, Alexis; Service de Réanimation/USC, Hôpital Mignot, Centre hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
Moine, Pierre; Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France
Legay, Francois; Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France
Voiriot, Guillaume; Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, and Groupe de Recherche Clinique CARMAS, Collegium Galilée, Créteil, France
Amara, Marlene; Service de Biologie (Unité de Microbiologie), Hôpital Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
Santi, Francesca; Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France
Nseir, Saad; Centre de Réanimation, CHU de Lille, 59000, Lille, France ; INSERM U1285, Université de Lille, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France
Marque-Juillet, Stephanie; Service de Biologie (Unité de Microbiologie), Hôpital Mignot, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
Bounab, Rania; Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France
Barbarot, Nicolas; Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France
Bruneel, Fabrice; Service de Réanimation/USC, Hôpital Mignot, Centre hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
Luyt, Charles-Edouard ; Service de Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne-Université, Hôpital Pitié-Salpêtrière, and Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, 47-83, Boulevard de l'Hôpital, 75651, Paris, France. charles-edouard.luyt@aphp.fr
COVID ICU Bacteremia Study Group on behalf of the COVID-ICU Investigators
We thank all investigators from the COVID-ICU Bacteremia Study Group, who were involved in the development of this study: S Nseir, K Razazi, M Fartoukh, G Voiriot, A Rouzé, CE Luyt, V Maxime, P Moine, F Santi, R Bounab, D Annane, N Massart, P Fillatre, F Legay, N Barbarot, F Bruneel, M Amara, S Marque-Juillet, A Ferre. We gratefully acknowledge all the French, Belgian, and Swiss clinical research centers, COVID-ICU investigators, the medical students, Polytechnic University students, and patients involved in the study. Participating sites and COVID-ICU investigators: CHU Angers, Angers, France.This study was funded by the Fondation APHP and its donators through the program “Alliance Tous Unis Contre le Virus”, the Direction de la Recherche Clinique et du Développement, and the French Ministry of Health and the foundation of the University hospitals of Geneva, Geneva, Switzerland. The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This study was funded by Ministère des Affaires Sociales, de la Santé et des Droits des Femmes.
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