Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units

Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). This retro...

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Published in:	The Journal of hospital infection Vol. 126; pp. 109 - 115
Main Authors:	de Macedo, V., Santos, G.S., Silva, R.N., Couto, C.N.M., Bastos, C., Viecelli, E., Mateus, M.N., Graf, M.E., Gonçalves, R.B., Silva, M.A., Bernardini, P.D.B., Grando, R.S.P., Boaventura, V.P., Pereira, H.S.R., Levin, A.S.S.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-08-2022 Published by Elsevier Ltd on behalf of The Healthcare Infection Society
Subjects:	COVID-19 Epidemiology Fatality or mortality Healthcare-associated infections Intensive care unit Risk factors COVID-19 Fatality or mortality Epidemiology Intensive care unit Risk factors Healthcare-associated infections
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Summary:	Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43–2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70–2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78–28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31–10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88–0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0195-6701 1532-2939
DOI:	10.1016/j.jhin.2022.05.013