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. 2021 Feb;47(2):180-187.
doi: 10.1007/s00134-021-06346-w. Epub 2021 Jan 27.

COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network

Niccolò Buetti #  1   2 , Stéphane Ruckly #  1 , Etienne de Montmollin  1   3 , Jean Reignier  4 , Nicolas Terzi  5   6 , Yves Cohen  7   8   9 , Shidasp Siami  10 , Claire Dupuis  1   11 , Jean-François Timsit  12   13
Affiliations

COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network

Niccolò Buetti et al. Intensive Care Med. 2021 Feb.

Erratum in

Abstract

Purpose: The primary objective of this study was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Subsequently, we performed secondary analyses in order to explain the observed results.

Methods: We conducted a matched case-cohort study, based on prospectively collected data from a large ICU cohort in France. Critically ill COVID-19 patients were matched with similar non-COVID-19 patients. ICU-BSI was defined by an infection onset occurring > 48 h after ICU admission. We estimated the effect of COVID-19 on the probability to develop an ICU-BSI using proportional subdistribution hazards models.

Results: We identified 321 COVID-19 patients and 1029 eligible controls in 6 ICUs. Finally, 235 COVID-19 patients were matched with 235 non-COVID-19 patients. We observed 43 ICU-BSIs, 35 (14.9%) in the COVID-19 group and 8 (3.4%) in the non-COVID-19 group (p ≤ 0.0001), respectively. ICU-BSIs of COVID-19 patients were more frequently of unknown source (47.4%). COVID-19 patients had an increased probability to develop ICU-BSI, especially after 7 days of ICU admission. Using proportional subdistribution hazards models, COVID-19 increased the daily risk to develop ICU-BSI (sHR 4.50, 95% CI 1.82-11.16, p = 0.0012). Among COVID-19 patients (n = 235), a significantly increased risk for ICU-BSI was detected in patients who received tocilizumab or anakinra (sHR 3.20, 95% CI 1.31-7.81, p = 0.011) but not corticosteroids.

Conclusions: Using prospectively collected multicentric data, we showed that the ICU-BSI risk was higher for COVID-19 than non-COVID-19 critically ill patients after seven days of ICU stay. Clinicians should be particularly careful on late ICU-BSIs in COVID-19 patients. Tocilizumab or anakinra may increase the ICU-BSI risk.

Keywords: Bloodstream infection; COVID-19; Hospital-acquired; ICU; SARS-CoV-2.

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Conflict of interest statement

The authors have disclosed that they do not have conflict of interest. NT reports fees from Pfizer outside the submitted work. JFT reports, outside the submitted work, participations to advisory boards for Pfizer, MSD, Nabriva, Medimune, Gilead, Becton–Dickinson, and lecture fees from MSD, Pfizer, Biomerieux.

Figures

Fig. 1
Fig. 1
Flowchart. ICU intensive care unit, LOS length of stay, BSI bloodstream infection
Fig. 2
Fig. 2
Kaplan–Meier with the time to bloodstream infection in COVID-19 and non-COVID-19 patients. BSI bloodstream infection, T0 is the day of ICU admission
See this image and copyright information in PMC

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