Antimicrobial prescription in severe COVID-19 and CAP: a matched case-control study.

BACKGROUND: In severe coronavirus diseases 2019 (COVID-19), a high and potentially excessive use of antimicrobials for suspected bacterial co-infection and intensive care unit (ICU)-acquired infections has been repeatedly reported. OBJECTIVES: To compare an ICU cohort of community-acquired pneumonia (CAP) with a cohort of severe COVID-19 pertaining to co-infections, ICU-acquired infections and associated antimicrobial consumption. METHODS: We retrospectively compared a cohort of CAP patients with a cohort of COVID-19 patients matched according to organ failure, ICU length of stay (LOS) and ventilation days. Patient data such as demographics, infection focus, probability and severity, ICU severity scores and ICU and in-hospital mortality, days of antimicrobial therapy (DOT) and number of antimicrobial prescriptions, using an incremental scale, were registered and analysed. The total number of cultures (sputum, urinary, blood cultures) was collected and corrected for ICU LOS. FINDINGS: CAP patients (n = 148) were matched to COVID-19 patients (n = 74). Significantly less sputum cultures (68.2% versus 18.9%, P < 0.05) and bronchoalveolar lavages (BAL) (73.7% versus 36.5%, P < 0.05) were performed in COVID-19 patients. Six (8.1%) COVID-19 patients were diagnosed with a co-infection. Respectively, 58 of 148 (39.2%) CAP and 38 of 74 (51.4%) COVID-19 patients (P = 0.09) developed ICU-acquired infections. Antimicrobial distribution, both in the number of prescriptions and DOT, was similar in both cohorts. CONCLUSIONS: We found a low rate of microbiologically confirmed bacterial co-infection and a high rate of ICU-acquired infections in COVID-19 patients. Infection probabilities, antimicrobial prescriptions and DOT were comparable with a matched CAP cohort.

Staphylococcus aureus colonization at ICU admission as a risk factor for developing S. aureus ICU pneumonia.

OBJECTIVE: To quantify the incidence of intensive care unit (ICU)-acquired pneumonia caused by Staphylococcus aureus (S. aureus) and its association with S. aureus colonization at ICU admission. METHODS: This was a post-hoc analysis of two cohort studies in critically ill patients. The primary outcome was the incidence of microbiologically confirmed S. aureus ICU-acquired pneumonia. Incidences of S. aureus ICU pneumonia and associations with S. aureus colonization at ICU admission were determined using competing risks analyses. In all ICUs, patients were screened for respiratory tract S. aureus carriage on admission as part of infection control policies. Pooling of data was not deemed possible because of heterogeneity in baseline differences in patient population. RESULTS: The two cohort studies contained data of 9156 ICU patients. The average carriage rate of S. aureus among screened patients was 12.7%. In total, 1185 (12.9%) patients developed ICU pneumonia. Incidences of S. aureus ICU pneumonia were 1.33% and 1.08% in cohorts 1 and 2, respectively. After accounting for competing events, the adjusted subdistribution hazard ratio (SHR) of S. aureus colonization at admission for developing S. aureus ICU pneumonia was 9.55 (95% CI 5.31-17.18) in cohort 1 and 14.54 (95% CI 7.24-29.21) in cohort 2. CONCLUSION: The overall cumulative incidence of S. aureus ICU pneumonia in these ICUs was low. Patients colonized with S. aureus at ICU admission had an up to 15 times increased risk for developing this outcome compared with non-colonized patients.

Validity analysis of a unique infection surveillance system in the intensive care unit by analysis of a data warehouse built through a workflow-integrated software application.

BACKGROUND: An electronic decision support programme was developed within the intensive care unit (ICU) that provides an overview of all infection-related patient data, and allows ICU physicians to add clinical information during patient rounds, resulting in prospective compilation of a database. AIM: To assess the validity of computer-assisted surveillance (CAS) of ICU-acquired infection performed by analysis of this database. METHODS: CAS was compared with prospective paper-based surveillance (PBS) for ICU-acquired respiratory tract infection (RTI), bloodstream infection (BSI) and urinary tract infection (UTI) over four months at a 36-bed medical and surgical ICU. An independent panel reviewed the data in the case of discrepancy between CAS and PBS. FINDINGS: PBS identified 89 ICU-acquired infections (13 BSI, 18 UTI, 58 RTI) and CAS identified 90 ICU-acquired infections (14 BSI, 17 UTI, 59 RTI) in 876 ICU admissions. There was agreement between CAS and PBS on 13 BSI (100 %), 14 UTI (77.8 %) and 42 RTI (72.4 %). Overall, there was agreement on 69 infections (77.5%), resulting in a kappa score of 0.74. Discrepancy between PBS and CAS was the result of capture error in 11 and 14 infections, respectively. Interobserver disagreement on probability (13 RTI) and focus (two RTI, one UTI) occurred for 16 episodes. The time required to collect information using CAS is less than 30% of the time required when using PBS. CONCLUSION: CAS for ICU-acquired infection by analysis of a database built through daily workflow is a feasible surveillance method and has good agreement with PBS. Discrepancy between CAS and PBS is largely due to interobserver variability.