Institute of Microbiology, Department of Molecular and Translational Medicine, ASST Spedali Civili, University of Brescia, Brescia, Italy.
Division of Infectious and Tropical Diseases, ASST Spedali Civili, University of Brescia, Brescia, Italy.
J Med Virol. 2023 Jul;95(7):e28892. doi: 10.1002/jmv.28892.
Patients with viral infections are at higher risk to acquire bacterial and fungal superinfections associated with a worse prognosis. We explored this critical point in the setting of patients with severe COVID-19 disease. The study included 1911 patients admitted to intensive care unit (ICU) during a 2-year study period (March 2020-March 2022). Of them, 713 (37.3%) were infected with SARS-CoV-2 and 1198 were negative (62.7%). Regression analysis was performed to determine risk factors associated with the presence of bacterial and/or fungal superinfections in SARS-CoV-2 patients and to evaluate predictors of ICU mortality. Of the 713 patients with SARS-CoV-2 infection, 473 (66.3%) had respiratory and/or bloodstream bacterial and/or fungal superinfections, while of the 1198 COVID-19-negative patients, only 369 (30%) showed respiratory and/or bloodstream bacterial and/or fungal superinfections (p < 0.0001). Baseline characteristics of COVID-19 patients included a median age of 66 (interquartile range [IQR], 58-73), a predominance of males (72.7%), and the presence of a BMI higher than 24 (median 26; IQR, 24.5-30.4). Seventy-four percent (527, 73.9%) had one or more comorbidities and 135 (18.9%) of them had received previous antibiotic therapy. Furthermore, most of them (473, 66.3%) exhibited severe radiological pictures and needed invasive mechanical ventilation. Multivariate logistic regression analysis showed that 1 unit increment in BMI rises the risk of bacterial and/or fungal superinfections acquisition by 3% and 1-day increment in ICU stays rises the risk of bacterial and/or fungal superinfections acquisition by 11%. Furthermore, 1-day increment in mechanical ventilation rises the risk of bacterial and/or fungal superinfection acquisition by 2.7 times. Furthermore, patients with both bacterial and fungal infections had a significantly higher mortality rate than patients without superinfections (45.8% vs. 26.2%, p < 0.0001). Therefore, bacterial and fungal superinfections are frequent in COVID-19 patients admitted to ICU and their presence is associated with a worse outcome. This is an important consideration for targeted therapies in critically ill SARS-CoV-2 infected patients to improve their clinical course.
患有病毒感染的患者发生与预后较差相关的细菌和真菌感染的风险更高。我们在重症 COVID-19 患者中探讨了这一关键点。该研究纳入了在为期 2 年的研究期间（2020 年 3 月至 2022 年 3 月）入住重症监护病房（ICU）的 1911 名患者。其中，713 名（37.3%）感染了 SARS-CoV-2，1198 名呈阴性（62.7%）。进行回归分析以确定与 SARS-CoV-2 患者中存在细菌和/或真菌感染相关的危险因素，并评估 ICU 死亡率的预测因素。在 713 名感染 SARS-CoV-2 的患者中，473 名（66.3%）发生了呼吸道和/或血流细菌和/或真菌感染，而在 1198 名 COVID-19 阴性患者中，仅有 369 名（30%）发生了呼吸道和/或血流细菌和/或真菌感染（p<0.0001）。COVID-19 患者的基线特征包括中位年龄为 66 岁（四分位距 [IQR]，58-73 岁），男性居多（72.7%），体重指数（BMI）高于 24（中位数 26；IQR，24.5-30.4）。74%（527 名，73.9%）存在一种或多种合并症，其中 135 名（18.9%）曾接受过抗生素治疗。此外，他们中的大多数（473 名，66.3%）表现出严重的影像学图像，并需要有创机械通气。多变量逻辑回归分析显示，BMI 增加 1 个单位，发生细菌和/或真菌感染的风险增加 3%，ICU 入住时间增加 1 天，发生细菌和/或真菌感染的风险增加 11%。此外，机械通气增加 1 天，发生细菌和/或真菌感染的风险增加 2.7 倍。此外，合并细菌和真菌感染的患者死亡率明显高于无合并感染的患者（45.8% vs. 26.2%，p<0.0001）。因此，在 ICU 收治的 COVID-19 患者中，细菌和真菌感染很常见，且其存在与不良结局相关。这是对重症 SARS-CoV-2 感染患者进行靶向治疗以改善其临床病程的一个重要考虑因素。
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