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Hospital-Acquired Infections in Critically Ill Patients With COVID-19.
Grasselli, Giacomo; Scaravilli, Vittorio; Mangioni, Davide; Scudeller, Luigia; Alagna, Laura; Bartoletti, Michele; Bellani, Giacomo; Biagioni, Emanuela; Bonfanti, Paolo; Bottino, Nicola; Coloretti, Irene; Cutuli, Salvatore Lucio; De Pascale, Gennaro; Ferlicca, Daniela; Fior, Gabriele; Forastieri, Andrea; Franzetti, Marco; Greco, Massimiliano; Guzzardella, Amedeo; Linguadoca, Sara; Meschiari, Marianna; Messina, Antonio; Monti, Gianpaola; Morelli, Paola; Muscatello, Antonio; Redaelli, Simone; Stefanini, Flavia; Tonetti, Tommaso; Antonelli, Massimo; Cecconi, Maurizio; Foti, Giuseppe; Fumagalli, Roberto; Girardis, Massimo; Ranieri, Marco; Viale, Pierluigi; Raviglione, Mario; Pesenti, Antonio; Gori, Andrea; Bandera, Alessandra.
  • Grasselli G; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Scaravilli V; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Mangioni D; Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Scudeller L; Direzione Scientifica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Alagna L; Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Bartoletti M; Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
  • Bellani G; Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Biagioni E; Department of Anesthesia and Intensive Care Unit, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy.
  • Bonfanti P; Infectious Diseases Unit, San Gerardo Hospital ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Bottino N; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Coloretti I; Department of Anesthesia and Intensive Care Unit, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy.
  • Cutuli SL; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Sacred Heart Catholic University, Rome, Italy.
  • De Pascale G; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Sacred Heart Catholic University, Rome, Italy.
  • Ferlicca D; Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy.
  • Fior G; Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Forastieri A; Department of Anesthesia and Intensive Care, A. Manzoni Hospital, ASST Lecco, Lecco, Italy.
  • Franzetti M; Infectious Diseases Unit, A. Manzoni Hospital, ASST Lecco, Lecco, Italy.
  • Greco M; Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Guzzardella A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Linguadoca S; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Meschiari M; Infectious Diseases Clinics, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy.
  • Messina A; Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Monti G; Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Morelli P; Infectious Disease Unit, Hospital Health Direction, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Muscatello A; Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Redaelli S; Department of Anesthesia and Intensive Care, A. Manzoni Hospital, ASST Lecco, Lecco, Italy.
  • Stefanini F; Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
  • Tonetti T; Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy.
  • Antonelli M; Department of Anesthesiology, Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Sacred Heart Catholic University, Rome, Italy.
  • Cecconi M; Department of Anaesthesia and Intensive Care, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  • Foti G; Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Fumagalli R; Dipartimento di Anestesia e Rianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
  • Girardis M; Department of Anesthesia and Intensive Care Unit, AOU Policlinico and University of Modena and Reggio Emilia, Modena, Italy.
  • Ranieri M; Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Alma Mater Studiorum University of Bologna, Bologna, Italy.
  • Viale P; Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
  • Raviglione M; Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy.
  • Pesenti A; Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Gori A; Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy. Electronic address: andrea.gori@unimi.it.
  • Bandera A; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Chest ; 160(2): 454-465, 2021 08.
Article in English | MEDLINE | ID: covidwho-1184884
ABSTRACT

BACKGROUND:

Few small studies have described hospital-acquired infections (HAIs) occurring in patients with COVID-19. RESEARCH QUESTION What characteristics in critically ill patients with COVID-19 are associated with HAIs and how are HAIs associated with outcomes in these patients? STUDY DESIGN AND

METHODS:

Multicenter retrospective analysis of prospectively collected data including adult patients with severe COVID-19 admitted to eight Italian hub hospitals from February 20, 2020, through May 20, 2020. Descriptive statistics and univariate and multivariate Weibull regression models were used to assess incidence, microbial cause, resistance patterns, risk factors (ie, demographics, comorbidities, exposure to medication), and impact on outcomes (ie, ICU discharge, length of ICU and hospital stays, and duration of mechanical ventilation) of microbiologically confirmed HAIs.

RESULTS:

Of the 774 included patients, 359 patients (46%) demonstrated 759 HAIs (44.7 infections/1,000 ICU patient-days; 35% multidrug-resistant [MDR] bacteria). Ventilator-associated pneumonia (VAP; n = 389 [50%]), bloodstream infections (BSIs; n = 183 [34%]), and catheter-related BSIs (n = 74 [10%]) were the most frequent HAIs, with 26.0 (95% CI, 23.6-28.8) VAPs per 1,000 intubation-days, 11.7 (95% CI, 10.1-13.5) BSIs per 1,000 ICU patient-days, and 4.7 (95% CI, 3.8-5.9) catheter-related BSIs per 1,000 ICU patient-days. Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of cases of VAP, respectively. Variables independently associated with infection were age, positive end expiratory pressure, and treatment with broad-spectrum antibiotics at admission. Two hundred thirty-four patients (30%) died in the ICU (15.3 deaths/1,000 ICU patient-days). Patients with HAIs complicated by septic shock showed an almost doubled mortality rate (52% vs 29%), whereas noncomplicated infections did not affect mortality. HAIs prolonged mechanical ventilation (median, 24 days [interquartile range (IQR), 14-39 days] vs 9 days [IQR, 5-13 days]; P < .001), ICU stay (24 days [IQR, 16-41 days] vs 9 days [IQR, 6-14 days]; P = .003), and hospital stay (42 days [IQR, 25-59 days] vs 23 days [IQR, 13-34 days]; P < .001).

INTERPRETATION:

Critically ill patients with COVID-19 are at high risk for HAIs, especially VAPs and BSIs resulting from MDR organisms. HAIs prolong mechanical ventilation and hospitalization, and HAIs complicated by septic shock almost double mortality. TRIAL REGISTRY ClinicalTrials.gov; No. NCT04388670; URL www.clinicaltrials.gov.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Chest Year: 2021 Document Type: Article Affiliation country: J.chest.2021.04.002

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cross Infection / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Chest Year: 2021 Document Type: Article Affiliation country: J.chest.2021.04.002