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. 2021 Dec 24;11(1):183.
doi: 10.1186/s13613-021-00971-w.

Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Nicolas Massart #  1 , Virginie Maxime #  2 , Pierre Fillatre  1 , Keyvan Razazi  3   4   5 , Alexis Ferré  6 , Pierre Moine  2 , Francois Legay  1 , Guillaume Voiriot  7 , Marlene Amara  8 , Francesca Santi  2 , Saad Nseir  9   10 , Stephanie Marque-Juillet  8 , Rania Bounab  2 , Nicolas Barbarot  1 , Fabrice Bruneel #  6 , Charles-Edouard Luyt #  11 ; COVID ICU Bacteremia Study Group on behalf of the COVID-ICU Investigators
Collaborators, Affiliations

Characteristics and prognosis of bloodstream infection in patients with COVID-19 admitted in the ICU: an ancillary study of the COVID-ICU study

Nicolas Massart et al. Ann Intensive Care. .

Erratum in

Abstract

Background: Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients.

Patients and methods: We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching.

Results: Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05-1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population.

Conclusion: COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.

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Conflict of interest statement

CEL has served as consultant for Bayer Healthcare, Carmat and Thermo Fisher Brahms, and received lecture fees from MSD, Aerogen and BioMérieux, outside the submitted work. The other authors have no conflicts of interest to declare in relationship to this manuscript.

Figures

Fig. 1
Fig. 1
Flow chart of the study. ICU, intensive care unit. BSI, bloodstream infection. *1243 (989 in the no BSI group and 245 in the BSI group) patients had missing data among variables used for matching process and were, therefore, excluded from matched analysis
Fig. 2
Fig. 2
Cumulative incidence of bloodstream infection (BSI) as a function of time. ICU: intensive care unit. In 40 out of the 780 patients with BSI, BSI occurred after 21 days in the ICU. Precise day of BSI occurrence for these 40 patients is not known
Fig. 3
Fig. 3
Kaplan–Meier analysis of survival in the matched patients with (n = 537) and without (n = 537) bloodstream infection (BSI). ICU: intensive care unit
See this image and copyright information in PMC

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