Bacterial and Fungal Infections Among COVID-19 Patients in Intensive Care Unit

Yıl 2025, Cilt: 7 Sayı: 1, 216 - 222, 15.01.2025

Deniz Gezer , Sencer Yurtsever , Seda Tezcan Ülger

https://doi.org/10.37990/medr.1527943

Öz

Aim: Secondary infections caused by bacteria or fungi are dangerous because they increase death rates, particularly in patients with COVID-19 who are receiving intensive care. In this study, hospital-associated secondary infections resulting from bacteria and fungi amid COVID-19 patients treated in intensive care units, as well as their distribution according to microbial agents, were investigated.
Material and Method: The study comprised 134 COVID-19 patients who were being treated in the Mersin City Hospital of the Ministry of Health intensive care unit between January 1, 2021, and April 30, 2021. The patients’ demographics and clinical records, as well as bacterial and fungal infections in the blood, urine and deep tracheal aspirate samples, were analyzed retrospectively.
Results: The rate of secondary infection was found to be quite high in patients hospitalized in intensive care units for over 72 hours (91.4%). The majority of secondary infections were detected in blood samples (n=103, 15%). Secondary infection was detected in 61 (8.9%) deep tracheal aspirate specimens and 59 (8.5%) urine samples. The most common secondary infectious agents were Candida spp. (22.3%), Acinetobacter baumannii (16.8%). In addition, it was determined that ≥60 years and ≥3 days of mechanical ventilation independently increased the probability of developing secondary infection.
Conclusion: Our findings are emphasized that the concern of secondary infection due to Candida spp., Acinetobacter baumanii and Stahylococcus epidermidis agents. Evaluation of bacterial superinfections during the later waves of the pandemic may be critical, especially given the changes in the management of these patients, such as the routine use of corticosteroids and the raise of the different variants of the SARS-CoV-2.

Anahtar Kelimeler

Corticosteroids , COVID-19 , intensive care unit , secondary infection

Etik Beyan

The Scientific Research Platform of the General Directorate of Health Services of the Turkish Ministry of Health granted authorization for this research. This research was conducted with the permission of the Mersin University Clinical Research Ethics Committee (Decision No: 2021/480 and Date: 07/14/2021).

Destekleyen Kurum

none

Proje Numarası

none

Teşekkür

.

Kaynakça

• Zhu N, Zhang D, Wang W, et al.; China novel coronavirus investigating and research team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727-33.
• Loeffelholz MJ, Tang YW. Laboratory diagnosis of emerging human coronavirus infections - the state of the art. Emerg Microbes Infect. 2020;9:747-56.
• Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021;19:141-54. Erratum in: Nat Rev Microbiol. 2022;20:315.
• Horby P, Lim WS, Emberson JR, et al.; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384:693-704.
• MacIntyre CR, Chughtai AA, Barnes M, et al. The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. BMC Infect Dis. 2018;18:637.
• Sang L, Xi Y, Lin Z, et al. Secondary infection in severe and critical COVID-19 patients in China: a multicenter retrospective study. Ann Palliat Med. 2021;10:8557-70.
• Lai CC, Wang CY, Hsueh PR. Co-infections among patients with COVID-19: the need for combination therapy with non-anti-SARS-CoV-2 agents?. J Microbiol Immunol Infect. 2020;53:505-12.
• Sharifipour E, Shams S, Esmkhani M, et al. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis. 2020;20:646.
• T. C. Sağlık Bakanlığı COVID-19 Salgın Yönetimi ve Çalışma Rehberi. https://covid19.saglik.gov.tr/TR-66393/covid-19-salgin-yonetimi-ve-calisma-rehberi.html access date 08.05.2022.
• Westblade LF, Simon MS, Satlin MJ. Bacterial coinfections in Coronavirus Disease 2019. Trends Microbiol. 2021;29:930-41.
• Battaglini D, Robba C, Fedele A, et al. The role of dysbiosis in critically Ill patients with COVID-19 and acute respiratory distress syndrome. Front Med (Lausanne). 2021;8:671714.
• Posteraro B, De Angelis G, Menchinelli G, et al. Risk factors for mortality in adult COVID-19 patients who develop bloodstream infections mostly caused by antimicrobial-resistant organisms: analysis at a large teaching hospital in Italy. J Clin Med. 2021;10:1752.
• Ong CCH, Farhanah S, Linn KZ, et al. Nosocomial infections among COVID-19 patients: an analysis of intensive care unit surveillance data. Antimicrob Resist Infect Control. 2021;10:119.
• Bardi T, Pintado V, Gomez-Rojo M, et al. Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome. Eur J Clin Microbiol Infect Dis. 2021;40:495-502.
• Grasselli G, Scaravilli V, Mangioni D, et al. Hospital-acquired infections in critically ill patients with COVID-19. Chest. 2021;160:454-65.
• Zhang H, Zhang Y, Wu J, et al. Risks and features of secondary infections in severe and critical ill COVID-19 patients. Emerg Microbes Infect. 2020;9:1958-64.
• Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021;49:591-605.
• Obata R, Maeda T, Rizk D, Kuno T. Increased secondary infection in COVID-19 patients treated with steroids in New York City. Jpn J Infect Dis. 2021;74:307-15.
• Bhatt PJ, Shiau S, Brunetti L, et al. Risk factors and outcomes of hospitalized patients with severe Coronavirus Disease 2019 (COVID-19) and secondary bloodstream infections: a multicenter case-control study. Clin Infect Dis. 2021;72:e995-1003.
• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. Erratum in: Lancet. 2020;395:1038.
• Avan Mutlu T, Bozok T. Identification of bacterial agents isolated from lower respiratory samples of COVID-19 patients and investigation of their antibacterial resistance patterns. Turk Mikrobiyol Cemiy Derg. 2022;52:48-55.
• Costa RLD, Lamas CDC, Simvoulidis LFN, et al. Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: impact of gram-negative bacterial resistance. Rev Inst Med Trop Sao Paulo. 2022;64:e6.
• Yang S, Hua M, Liu X, et al. Bacterial and fungal co-infections among COVID-19 patients in intensive care unit. Microbes Infect. 2021;23:104806.