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Multicenter Study
. 2020 Dec;9(1):1958-1964.
doi: 10.1080/22221751.2020.1812437.

Risks and features of secondary infections in severe and critical ill COVID-19 patients

Haocheng Zhang  1 , Yi Zhang  1 , Jing Wu  1 , Yang Li  1 , Xian Zhou  1 , Xin Li  2 , Haili Chen  2 , Mingquan Guo  2 , Shu Chen  1 , Feng Sun  1 , Richeng Mao  1 , Chao Qiu  1 , Zhaoqin Zhu  2 , Jingwen Ai  1 , Wenhong Zhang  1
Affiliations
Multicenter Study

Risks and features of secondary infections in severe and critical ill COVID-19 patients

Haocheng Zhang et al. Emerg Microbes Infect. 2020 Dec.

Abstract

Objectives Severe or critical COVID-19 is associated with intensive care unit admission, increased secondary infection rate, and would lead to significant worsened prognosis. Risks and characteristics relating to secondary infections in severe COVID-19 have not been described. Methods Severe and critical COVID-19 patients from Shanghai were included. We collected lower respiratory, urine, catheters, and blood samples according to clinical necessity and culture and mNGS were performed. Clinical and laboratory data were archived. Results We found 57.89% (22/38) patients developed secondary infections. The patient receiving invasive mechanical ventilation or in critical state has a higher chance of secondary infections (P<0.0001). The most common infections were respiratory, blood-stream and urinary infections, and in respiratory infections, the most detected pathogens were gram-negative bacteria (26, 50.00%), following by gram-positive bacteria (14, 26.92%), virus (6, 11.54%), fungi (4, 7.69%), and others (2, 3.85%). Respiratory Infection rate post high flow, tracheal intubation, and tracheotomy were 12.90% (4/31), 30.43% (7/23), and 92.31% (12/13) respectively. Secondary infections would lead to lower discharge rate and higher mortality rate. Conclusion Our study originally illustrated secondary infection proportion in severe and critical COVID-19 patients. Culture accompanied with metagenomics sequencing increased pathogen diagnostic rate. Secondary infections risks increased after receiving invasive respiratory ventilations and intravascular devices, and would lead to a lower discharge rate and a higher mortality rate.

Keywords: COVID-19; SARS-CoV-2; intensive care; intravascular devices; respiratory ventilations; secondary infection.

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Conflict of interest statement

All authors report no potential conflict of interest.

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Proportions and distributions of pathogens detected in different secondary infections. (A) Composition of pathogens in respiratory secondary infections. (B) Distributions of pathogens detected in respiratory secondary infections. The blue stripe indicated bacteria and fungi reported by culture, while grey stripe showed pathogens extra detected by mNGS. (C) Composition of pathogens in blood-stream secondary infections. (D) Distributions of pathogens detected in blood-stream secondary infections. The red stripe indicated bacteria and fungi reported by culture, while grey stripe showed pathogens extra detected by mNGS. (E) Composition of pathogens in urinary secondary infections.
Figure 2.
Figure 2.
Detection of secondary respiratory and blood-stream infection pathogens following clinical operations. (A) The median time indicated the infection period after accordingly respiratory support. (B) The median time indicated the infection period after different intravascular devices. P-value of median time was calculated and annotated on the right.
Figure 3.
Figure 3.
The outcome of COVID-19 patients with or without secondary infection.
See this image and copyright information in PMC

References

    1. Available from: https://ncov.dxy.cn/ncovh5/view/pneumonia?scene=2&clicktime=1579582186&e....
    1. Yap FH, Gomersall CD, Fung KS, et al. . Increase in methicillin-resistant Staphylococcus aureus acquisition rate and change in pathogen pattern associated with an outbreak of severe acute respiratory syndrome. Clin Infect Dis. 2004 Aug 15;39(4):511–516. doi: 10.1086/422641 - DOI - PMC - PubMed
    1. McCullers JA. The co-pathogenesis of influenza viruses with bacteria in the lung. Nat Rev Microbiol. 2014 Apr;12(4):252–262. doi: 10.1038/nrmicro3231 - DOI - PubMed
    1. Yang X, Yu Y, Xu J, et al. . Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–481. doi: 10.1016/S2213-2600(20)30079-5 - DOI - PMC - PubMed
    1. Chen T, Wu D, Chen H, et al. . Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Br Med J. 2020 Mar 26;368:m1091. doi: 10.1136/bmj.m1091 - DOI - PMC - PubMed

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