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. 2021 Jan 18;9(1):10.
doi: 10.1186/s40560-021-00526-y.

Community-acquired and hospital-acquired respiratory tract infection and bloodstream infection in patients hospitalized with COVID-19 pneumonia

Kirstine K Søgaard  1   2 , Veronika Baettig  3 , Michael Osthoff  4   5 , Stephan Marsch  6 , Karoline Leuzinger  7 , Michael Schweitzer  8   9 , Julian Meier  9   10 , Stefano Bassetti  4   5 , Roland Bingisser  11 , Christian H Nickel  11 , Nina Khanna  3 , Sarah Tschudin-Sutter  3   5 , Maja Weisser  3 , Manuel Battegay  3 , Hans H Hirsch  3   7   12 , Hans Pargger  6 , Martin Siegemund  5   6 , Adrian Egli  13   14
Affiliations

Community-acquired and hospital-acquired respiratory tract infection and bloodstream infection in patients hospitalized with COVID-19 pneumonia

Kirstine K Søgaard et al. J Intensive Care. .

Abstract

Objectives: SARS-CoV-2 may cause acute lung injury, and secondary infections are thus relevant complications in patients with COVID-19 pneumonia. However, detailed information on community- and hospital-acquired infections among patients with COVID-19 pneumonia is scarce.

Methods: We identified 220 SARS-CoV-2-positive patients hospitalized at the University Hospital Basel, Switzerland (between 25 February and 31 May 2020). We excluded patients who declined the general consent (n = 12), patients without clinical evidence of pneumonia (n = 29), and patients hospitalized for < 24 h (n = 17). We evaluated the frequency of community- and hospital-acquired infections using respiratory and blood culture materials with antigen, culture-based, and molecular diagnostics. For ICU patients, all clinical and microbial findings were re-evaluated interdisciplinary (intensive care, infectious disease, and clinical microbiology), and agreement reached to classify patients with infections.

Results: In the final cohort of 162 hospitalized patients (median age 64.4 years (IQR, 50.4-74.2); 61.1% male), 41 (25.3%) patients were admitted to the intensive care unit, 34/41 (82.9%) required mechanical ventilation, and 17 (10.5%) of all hospitalized patients died. In total, 31 infections were diagnosed including five viral co-infections, 24 bacterial infections, and three fungal infections (ventilator-associated pneumonia, n = 5; tracheobronchitis, n = 13; pneumonia, n = 1; and bloodstream infection, n = 6). Median time to respiratory tract infection was 12.5 days (IQR, 8-18) and time to bloodstream infection 14 days (IQR, 6-30). Hospital-acquired bacterial and fungal infections were more frequent among ICU patients than other patients (36.6% vs. 1.7%). Antibiotic or antifungal treatment was administered in 71 (43.8%) patients.

Conclusions: Community-acquired viral and bacterial infections were rare among COVID-19 pneumonia patients. By contrast, hospital-acquired bacterial or fungal infections were frequently complicating the course among ICU patients.

Keywords: Bacterial secondary infections; COVID-19; Pneumonia; SARS-CoV-2; Sepsis.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1
Fig. 1
Flowchart depicting the cohort
See this image and copyright information in PMC

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