Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Microbiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
J Antimicrob Chemother. 2021 Mar 12;76(4):1078-1084. doi: 10.1093/jac/dkaa530.
Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19.
To identify predictors of superinfections in COVID-19.
Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections.
Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11-29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5-39.5, P < 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4-13.1, P < 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2-11.8, P < 0.001); C-reactive protein on admission >7 mg/dl (OR 3.59, 95% CI 1.7-7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1-7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P < 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445).
The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.
细菌和真菌感染可能会使 COVID-19 住院患者的病情复杂化。
确定 COVID-19 患者发生合并感染的预测因素。
这是一项前瞻性、观察性研究，纳入了 2020 年 3 月 4 日至 4 月 30 日期间连续入住意大利比萨大学医院的 COVID-19 患者。记录了临床数据和结局。合并感染定义为在入院后≥48 小时发生的细菌或真菌感染。采用多变量分析确定与合并感染独立相关的因素。
共有 315 例 COVID-19 患者住院，69 例（21.9%）患者发生 109 例合并感染。从入院到合并感染的中位时间为 19 天（范围 11-29.75）。合并感染由肠杆菌科（44.9%）、非发酵革兰阴性杆菌（15.6%）、革兰阳性菌（15.6%）和真菌（5.5%）引起。混合感染占 18.3%。合并感染的预测因素包括：耐碳青霉烯肠杆菌科的肠道定植（OR 16.03，95%CI 6.5-39.5，P<0.001）；有创机械通气（OR 5.6，95%CI 2.4-13.1，P<0.001）；免疫调节剂（托珠单抗/巴瑞替尼）（OR 5.09，95%CI 2.2-11.8，P<0.001）；入院时 C 反应蛋白>7mg/dl（OR 3.59，95%CI 1.7-7.7，P=0.001）；以及先前使用哌拉西林/他唑巴坦治疗（OR 2.85，95%CI 1.1-7.2，P=0.028）。与未发生合并感染的患者相比，发生合并感染的患者住院时间更长（30 天 vs. 11 天，P<0.001），而死亡率相似（18.8% vs. 23.2%，P=0.445）。
COVID-19 患者发生细菌和真菌感染的风险相当。需要经验性使用广谱抗生素和免疫调节剂的患者应谨慎选择。必须加强感染控制措施。
