Nosocomial infections amongst critically ill COVID-19 patients in Australia

https://doi.org/10.1016/j.jcvp.2021.100054Get rights and content
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Highlights

  • The frequency of bloodstream infections and hospital-acquired pneumonia in critically ill patients with COVID-19 admitted to Australian intensive care units was low compared to international comparators.

  • Both bloodstream infections and hospital-acquired pneumonia were independently associated with prolonged intensive care unit length of stay, and hospital-acquired pneumonia with prolonged hospital lengths of stay, but not with a greater risk of hospital mortality.

  • Microbiological pattern of pulmonary colonization and hospital-acquired pneumonia in critically ill patients with COVID-19 was different to that previously described with influenza, with more gram-negative organisms and less Staphylococcus aureus.

Abstract

Purpose

To determine the frequency of nosocomial infections including hospital-acquired pneumonia (HAP) and bloodstream infection (BSI), amongst critically ill patients with COVID-19 infection in Australian ICUs and to evaluate associations with mortality and length of stay (LOS).

Methods

The effect of nosocomial infections on hospital mortality was evaluated using hierarchical logistic regression models to adjust for illness severity and mechanical ventilation.

Results

There were 490 patients admitted to 55 ICUs during the study period. Adjusted odds ratio (OR) for hospital mortality was 1.61 (95% confidence interval (CI) 0.61–4.27, p = 0.3) when considering BSI, and 1.76 (95% CI 0.73–4.21, p = 0.2) for HAP. The average adjusted ICU LOS was significantly longer for patients with BSI (geometric mean 9.0 days vs 6.3 days, p = 0.04) and HAP (geometric mean 13.9 days vs 6.0 days p<0.001).

Conclusion

Nosocomial infection rates amongst patients with COVID-19 were low and their development was associated with a significantly longer ICU LOS.

Keywords

COVID-19
Critical care
Bloodstream infections
Nosocomial infections
Healthcare-associated pneumonia

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