Secondary infections in mechanically ventilated patients with COVID-19: An overlooked matter?

Introduction. The susceptibility to infection probably increases in COVID-19 patients due to a combination of virusand drug-induced immunosuppression. The reported rate of secondary infections was quite low in previous studies. The objectives of our study were to investigate the rate of secondary infections, risk factors for secondary infections and risk factors for mortality in COVID-19 critically ill patients. Material and methods. We performed a single-center retrospective study in mechanically ventilated critically ill COVID-19 patients admitted to our Critical Care Unit (CCU). We recorded the patients’ demographic data; clinical data; microbiology data and incidence of secondary infection during CCU stay, including ventilator-associated pneumonia (VAP) and nosocomial bacteremia (primary and secondary). Results. A total of 107 patients with a mean age 62.2 ± 10.6 years were included. Incidence of secondary infection during CCU stay was 43.0% (46 patients), including nosocomial bacteremia (34 patients) and VAP (35 patients). Age was related to development of secondary infection (65.2 ± 7.3 vs. 59.9 ± 12.2 years, p=0.007). Age ≥ 65 years and secondary infection were independent predictors of mortality (OR=2.692, 95% CI 1.068-6.782, p<0.036; and OR=3.658, 95% CI 1.385- 9.660, p=0.009, respectively). The hazard ratio for death within 90 days in the ≥ 65 years group and in patients infected by antimicrobial resistant pathogens was 1.901 (95% CI 1.198- 3.018; p= 0.005 by log-rank test) and 1.787 (95% CI 1.023-3.122; p= 0.036 by log-rank test), respectively. Conclusions. Our data suggest that the incidence of secondary infection and infection by antimicrobial resistant pathogens is very high in critically ill patients with COVID-19 with a significant impact on prognosis.

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Clinical Features and Risk Factors for Secondary Infection in Critically Ill Patients With COVID-19

10.21203/rs.3.rs-100708/v1 ◽

2020 ◽

Author(s):

Tongtong Pan ◽

Dazhi Chen ◽

Yi Chen ◽

Chenwei Pan ◽

Feifei Su ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Clinical Features ◽

Critically Ill Patients ◽

Trigger Point ◽

Secondary Infection ◽

Infected Group ◽

Effective Control ◽

Utilization Rate ◽

Secondary Infections

Abstract Background: To analyze the clinical features and the possible risk factors of secondary infection, and explore their impact on prognosis of COVID-19. Methods: A total of 165 severe and critical hospitalized patients diagnosed with COVID-19 were included. The clinical characteristics, laboratory tests, imaging data, secondary infections and outcomes were analyzed. Results: The mean age of total patients was (57.3±15.2) years, of which 111 were males (67.3%). 108 cases were with basic diseases (65.5%), and 1 death (0.6%). The secondary infection rate in critical patients was significantly higher than in severe patients (P <0.05). The secondary infections were mainly lung infections. The pathogens were principally Burkholderia multivorans, Stenotrophomonas maltophilia, Acinetobacter baumannii and Klebsiella pneumoniae. The recovery rate of 28 days in the infected group was significantly lower than that in the non-infected group (p < 0.001).The utilization rate and usage time of invasive ventilator, and deep vein catheterization, catheter indwelling and ECMO were the risk factors for the secondary infected patients.Conclusion: Secondary infection is an extremely common complication in critically ill patients and a trigger point for exacerbation of the disease. An effective control on the secondary infection will do good to the prognosis of COVID-19 patients.

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Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Scientific Reports ◽

10.1038/s41598-021-90013-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yongfang Zhou ◽

Steven R. Holets ◽

Man Li ◽

Gustavo A. Cortes-Puentes ◽

Todd J. Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

History Of ◽

Training Background ◽

The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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Dyspnea In Mechanically Ventilated Critically-ill Patients: Prevalence And Risk Factors

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a3014 ◽

2010 ◽

Author(s):

Matthieu Schmidt ◽

Alexandre Demoule ◽

Andrea Polito ◽

Raphael Porchet ◽

Jerome Aboab ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Mechanically Ventilated

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RISK FACTORS FOR ACINETOBACTER BAUMANNII (AB) NOSOCOMIAL BACTEREMIA IN CRITICALLY ILL PATIENTS

Critical Care Medicine ◽

10.1097/00003246-199901001-00348 ◽

1999 ◽

Vol 27 (Supplement) ◽

pp. 127A

Author(s):

JL Garcia-Garmendia ◽

J Gamacho-Montero ◽

C Ortiz-Leyba ◽

FJ Jimenez-Jimenez ◽

M. Gili-Miner

Keyword(s):

Risk Factors ◽

Acinetobacter Baumannii ◽

Critically Ill ◽

Critically Ill Patients ◽

Nosocomial Bacteremia

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Secondary bloodstream infection in critically ill patients with COVID-19

Journal of International Medical Research ◽

10.1177/03000605211062783 ◽

2021 ◽

Vol 49 (12) ◽

pp. 030006052110627

Author(s):

Junli Zhang ◽

Peng Lan ◽

Jun Yi ◽

Changming Yang ◽

Xiaoyan Gong ◽

...

Keyword(s):

Risk Factors ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Critically Ill ◽

Nasogastric Tube ◽

Critically Ill Patients ◽

Secondary Infection ◽

Venous Catheter ◽

Urethral Catheter ◽

Central Venous

Objective Secondary infection, especially bloodstream infection, is an important cause of death in critically ill patients with COVID-19. We aimed to describe secondary bloodstream infection (SBI) in critically ill adults with COVID-19 in the intensive care unit (ICU) and to explore risk factors related to SBI. Methods We reviewed all SBI cases among critically ill patients with COVID-19 from 12 February 2020 to 24 March 2020 in the COVID-19 ICU of Jingmen First People's Hospital. We compared risk factors associated with bloodstream infection in this study. All SBIs were confirmed by blood culture. Results We identified five cases of SBI among the 32 patients: three with Enterococcus faecium, one mixed septicemia ( E. faecium and Candida albicans), and one C. parapsilosis. There were no significant differences between the SBI group and non-SBI group. Significant risk factors for SBI were extracorporeal membrane oxygenation, central venous catheter, indwelling urethral catheter, and nasogastric tube. Conclusions Our findings confirmed that the incidence of secondary infection, particularly SBI, and mortality are high among critically ill patients with COVID-19. We showed that long-term hospitalization and invasive procedures such as tracheotomy, central venous catheter, indwelling urethral catheter, and nasogastric tube are risk factors for SBI and other complications.

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Incidence of Acute Kidney Injury Among Intensive Care Unit Patients Receiving Vancomycin in Combination with Cefepime or Piperacillin–Tazobactam

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.799 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S336-S336

Author(s):

W Cliff Rutter ◽

David S Burgess

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Statistical Tests ◽

Demographic Data ◽

Calcineurin Inhibitors ◽

Kidney Injury ◽

Severity Of Illness ◽

University Of Kentucky ◽

History Of

Abstract Background Combination therapy with piperacillin-tazobactam (TZP) and vancomycin (VAN) has been associated with increased AKI incidence when compared with cefepime (FEP) and VAN. However, this was not seen in critically ill patients, we hypothesized that critically ill patients receiving TZP+VAN would have a higher AKI incidence compared with those receiving FEP+VAN. Methods Clinical and demographic data were collected from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust. Adult patients were included if they received TZP+VAN or FEP+VAN for ≥ 48 hours in the ICU. Patients were excluded for initial CrCl < 30 mL/minute, receipt of other β-lactam agents, past medical history of CKD. AKI cases were identified via the RIFLE criteria. Variables were analyzed via appropriate statistical tests. Patients were propensity score matched on a 1:1 basis on variables that were significantly different at baseline or associated with AKI. Results Overall, 1871 patients were included in this study, with 1205 receiving TZP+VAN and 666 receiving FEP+VAN. At baseline, TZP+VAN patients were older (56 [45–65] vs. 52 [37–63] years; P < 0.00001). Vasopressor exposure was more common in the FEP+VAN group (32.6% vs. 27.0%, P = 0.01). AKI incidence was higher in the TZP+VAN group (31.8% vs. 18.0%, P < 0.00001). Following matching, 1282 patients were included with 641 patients in each group. The cohorts were similar in baseline AKI risk factors, except hypertension (TZP+VAN 59.4% vs. 53.4%, P = 0.03), and loop diuretic exposure (53.4% vs. 46.7%, P = 0.02). AKI was significantly more common in TZP+VAN patients (34.2% vs. 17.8%, P < 0.00001) and after controlling for remaining confounders, TZP+VAN had 2.51 times the odds of experiencing AKI than those in the FEP+VAN (95% CI 1.9–3.34). Other factors associated with increased odds of AKI included: increasing severity of illness, higher baseline renal function, exposure to calcineurin inhibitors, vasopressors, and loop diuretics, diagnosis of heart failure, and duration of antimicrobial therapy > 7 days. Conclusion TZP+VAN therapy is associated with significant increases in AKI in critically ill patients compared with those who received FEP+VAN independent of other AKI risk factors. Disclosures All authors: No reported disclosures.

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Invasive Fungal Disease in Critically Ill Patients at High Risk: Usefulness of Lymphocyte Subtyping

Journal of Intensive Care Medicine ◽

10.1177/0885066618800690 ◽

2018 ◽

Vol 35 (9) ◽

pp. 909-918 ◽

Cited By ~ 1

Author(s):

Jiahui Zhang ◽

Na Cui ◽

Hao Wang ◽

Wen Han ◽

Yuanfei Li ◽

...

Keyword(s):

T Cell ◽

High Risk ◽

Cell Count ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Fungal Disease ◽

Rank Test ◽

Icu Admission ◽

Cell Counts ◽

Log Rank Test

Objectives: This study aimed to investigate the distinguishing ability of lymphocyte subtyping for diagnosis and prognosis of invasive fungal disease (IFD). Methods: We assessed lymphocyte subtyping and evaluated the quantitative changes in key immunological parameters at intensive care unit (ICU) admission in critically ill patients at high risk and their potential influence on diagnosis and outcome of IFD. The primary outcome was 28-day mortality. Results: Among the 124 critically ill patients with mean Candida score 3.89 (0.76), 19 (15.3%) were in the IFD group. CD28+CD8+ T-cell counts (area under the curve [AUC] 0.899, 95% confidence interval [CI], 0.834-0.964, P < .001) had better distinguishing ability than other immune parameters for IFD diagnosis. The cutoff value of CD28+CD8+ T-cell counts at ICU admission for IFD diagnosis was 59.5 cells/mm3, with 83.3% sensitivity and 86.4% specificity. Multivariate logistic regression analysis identified CD28+CD8+ T-cell count <59.5 cells/mm3 (odds ratio 59.7, 95% CI, 7.33-486.9, P < .001) as an independent predictor for IFD diagnosis. CD28+CD8+ T-cell counts could also predict 28-day mortality (AUC 0.656, 95% CI, 0.525-0.788, P = .045). Kaplan-Meier survival analysis provided evidence that natural killer cell count <76.0 cells/mm3 (log-rank test; P = .001), CD8+ T-cell count <321.5 cells/mm3 (log-rank test; P = .04), and CD28+CD8+ T-cell count <129.0 cells/mm3 (log-rank test; P = .02) at ICU admission were associated with lower survival probabilities. Conclusion: CD28+CD8+ T-cell counts play an important role in early diagnosis of IFD. Low counts are associated with early mortality in critically ill patients at high risk of IFD. Our findings add evidence to the utility of lymphocyte subtyping in a diagnostic algorithm to better define IFD in critically ill patients at high risk.

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Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

10.21203/rs.3.rs-526150/v3 ◽

2021 ◽

Author(s):

Khalid Al Sulaiman ◽

Ohoud Al Juhani ◽

Khalid Bin Salah ◽

Ghazwa Koryem ◽

Khalid Eljaaly ◽

...

Keyword(s):

Single Dose ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Secondary Infection ◽

Demographic Data ◽

Vital Signs ◽

Multiple Doses ◽

Significant Difference

Abstract Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the 30-day mortality (HR 0.92; 95% CI, 0.48-1.75 p = 0.79) and in-hospital mortality (HR 0.69; 95% CI, 0.36-1.31 p = 0.25) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

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Nurses' Use of Non?pharmacological Interventions in Managing Common Risk Factors of Delirium in Critically Ill Patients

Journal of Clinical Research and Reports ◽

10.31579/2690-1919/151 ◽

2021 ◽

Vol 7 (3) ◽

pp. 01-04

Author(s):

Nahla Khalil

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Burn Patients ◽

Pharmacological Interventions ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Common Risk Factors ◽

Ventilated Patients

Incidence of delirium represented 32.3% since long in ICU settings, it might be higher. Other research showed the prevalence of delirium as high as 77% in ventilated burn patients. Incidence of delirium represented 32.3% since long in ICU settings, it might be higher. Other research showed the prevalence of delirium as high as 77% in ventilated burn patients. The incidence of delirium in the ICU ranged from 45% to 87%, this ratio appeared be different to the studied population exclusively to mechanically ventilated patients.

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Patient-Ventilator Asynchrony in Critically-Ill Adult Patients Undergoing Invasive Mechanical Ventilation: Incidence, Risk Factors and Outcomes

10.21203/rs.3.rs-129357/v1 ◽

2020 ◽

Author(s):

Yongfang Zhou ◽

Steven R Holets ◽

Man Li ◽

Gustavo A Cortes Puentes ◽

Todd J Meyer ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Mechanical Ventilation ◽

Adult Patients ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

Incidence Risk ◽

History Of

Abstract Background: Patient-ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background.Methods: A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥12 hours.Results: A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P<0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P<0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P<0.01).Conclusion: Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

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