Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study

Niccolò Buetti, Alexis Tabah, Ambre Loiodice, Stéphane Ruckly, Abdullah Tarik Aslan, Giorgia Montrucchio, Andrea Cortegiani, Nese Saltoglu, Bircan Kayaaslan, Firdevs Aksoy, Akova Murat, Özlem Akdoğan, Kemal Tolga Saracoglu, Cem Erdogan, Marc Leone, Ricard Ferrer, José-Artur Paiva, Yoshiro Hayashi, Mahesh Ramanan, Andrew Conway Morris, François Barbier, Jean-François Timsit, Eurobact 2 study group, Jeffrey Lipman, Edward Litton, Anna Maria Palermo, Timothy Yap, Ege Eroglu, Koji Hosokawa, Hideki Yoshida, Shigeki Fujitani, Farid Zand, Ata Mahmoodpoor, Seyed Mohammad Nasirodin Tabatabaei, Omar Elrabi, Ghaleb A Almekhlafi, Gabriela Vidal, Marta Aparicio, Irene Alonzo, Silvio A Namendys-Silva, Mariana Hermosillo, Roberto Alejandro Castillo, Liesbet De Bus, Jan De Waele, Isabelle Hollevoet, Nicolas De Schryver, Nicolas Serck, Pedja Kovacevic, Biljana Zlojutro, Etienne Ruppe, Philippe Montravers, Thierry Dulac, Jérémy Castanera, Alexandre Massri, Charlotte Guesdon, Pierre Garcon, Matthieu Duprey, François Philippart, Marc Tran, Cédric Bruel, Pierre Kalfon, Gaëtan Badre, Sophie Demeret, Loïc Le Guennec, Matteo Bassetti, Daniele Giacobbe, Gabriele Sales, Ivan Daroui, Giovanni Lodi, Mariachiara Ippolito, Davide Bellina, Andrea Di Guardo, Monica Rocco, Silvia Fiorelli, Adam Mikstacki, Mariusz Peichota, Iwona Pietraszek-Grzywaczewska, Pedro Póvoa, Andriy Krystopchuk, Ana Teresa, António Manuel Pereira de Figueiredo, Isabel Botelho, Vasco Costa, Rui Pedro Cunha, Alexey Gritsan, Vladislav Belskiy, Mikhail Furman, Maria Martinez, Vanessa Casares, Maria Pilar Gracia Arnillas, Rosana Munoz Bermudez, Alejandro Ubeda, Maria Salgado, Emilio Maseda, Alejandro Suarez De La Rica, Miguel Angel Blasco-Navalpotro, Alberto Orejas Gallego, Josef Prazak, J L Pagani, S Abed-Maillard, Arzu Topeli Iskit, Selcuk Mehtap, Solakoğlu Ceyhun, Ayşe Kaya Kalem, Ibrahim Kurt, Murat Telli, Barcin Ozturk, Nurcan Baykam, Ridvan Karaali, Iftihar Koksal, Yeliz Bilir, Seda Guzeldag, Gulden Ersoz, Guliz Evik, Yasar Bayindir, Yasemin Ersoy, Ari Ercole, Ashok Raj, Artemis Zormpa, George Tinaslanidis, Reena Khade, Ashraf Roshdy, Santhana Kannan, Supriya Antrolikar, Nicholas Marsden, Ben Attwood, Jamie Patel, Mohan Gurjar, Carol Dsilva, Jagadish Chandran, Bashir El Sanousi, Elfayadh Saidahmed, Hytham K S Hamid, Niccolò Buetti, Alexis Tabah, Ambre Loiodice, Stéphane Ruckly, Abdullah Tarik Aslan, Giorgia Montrucchio, Andrea Cortegiani, Nese Saltoglu, Bircan Kayaaslan, Firdevs Aksoy, Akova Murat, Özlem Akdoğan, Kemal Tolga Saracoglu, Cem Erdogan, Marc Leone, Ricard Ferrer, José-Artur Paiva, Yoshiro Hayashi, Mahesh Ramanan, Andrew Conway Morris, François Barbier, Jean-François Timsit, Eurobact 2 study group, Jeffrey Lipman, Edward Litton, Anna Maria Palermo, Timothy Yap, Ege Eroglu, Koji Hosokawa, Hideki Yoshida, Shigeki Fujitani, Farid Zand, Ata Mahmoodpoor, Seyed Mohammad Nasirodin Tabatabaei, Omar Elrabi, Ghaleb A Almekhlafi, Gabriela Vidal, Marta Aparicio, Irene Alonzo, Silvio A Namendys-Silva, Mariana Hermosillo, Roberto Alejandro Castillo, Liesbet De Bus, Jan De Waele, Isabelle Hollevoet, Nicolas De Schryver, Nicolas Serck, Pedja Kovacevic, Biljana Zlojutro, Etienne Ruppe, Philippe Montravers, Thierry Dulac, Jérémy Castanera, Alexandre Massri, Charlotte Guesdon, Pierre Garcon, Matthieu Duprey, François Philippart, Marc Tran, Cédric Bruel, Pierre Kalfon, Gaëtan Badre, Sophie Demeret, Loïc Le Guennec, Matteo Bassetti, Daniele Giacobbe, Gabriele Sales, Ivan Daroui, Giovanni Lodi, Mariachiara Ippolito, Davide Bellina, Andrea Di Guardo, Monica Rocco, Silvia Fiorelli, Adam Mikstacki, Mariusz Peichota, Iwona Pietraszek-Grzywaczewska, Pedro Póvoa, Andriy Krystopchuk, Ana Teresa, António Manuel Pereira de Figueiredo, Isabel Botelho, Vasco Costa, Rui Pedro Cunha, Alexey Gritsan, Vladislav Belskiy, Mikhail Furman, Maria Martinez, Vanessa Casares, Maria Pilar Gracia Arnillas, Rosana Munoz Bermudez, Alejandro Ubeda, Maria Salgado, Emilio Maseda, Alejandro Suarez De La Rica, Miguel Angel Blasco-Navalpotro, Alberto Orejas Gallego, Josef Prazak, J L Pagani, S Abed-Maillard, Arzu Topeli Iskit, Selcuk Mehtap, Solakoğlu Ceyhun, Ayşe Kaya Kalem, Ibrahim Kurt, Murat Telli, Barcin Ozturk, Nurcan Baykam, Ridvan Karaali, Iftihar Koksal, Yeliz Bilir, Seda Guzeldag, Gulden Ersoz, Guliz Evik, Yasar Bayindir, Yasemin Ersoy, Ari Ercole, Ashok Raj, Artemis Zormpa, George Tinaslanidis, Reena Khade, Ashraf Roshdy, Santhana Kannan, Supriya Antrolikar, Nicholas Marsden, Ben Attwood, Jamie Patel, Mohan Gurjar, Carol Dsilva, Jagadish Chandran, Bashir El Sanousi, Elfayadh Saidahmed, Hytham K S Hamid

Abstract

Background: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients.

Methods: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients' characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models.

Results: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49-2.45).

Conclusions: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

Keywords: Bacteremia; Bloodstream infection; COVID-19; Enterococcus; ICU-acquired.

Conflict of interest statement

The authors have disclosed that they do not have conflict of interest. Dr. Buetti received a grant from the Swiss National Science Foundation (Grant Number: P4P4PM_194449). Prof. Timsit received fees for lectures to 3M, MSD, Pfizer, and BioMérieux; he received research grants from Astellas, 3M, MSD, and Pfizer; and he participated to advisory boards of 3M, MSD, Bayer Pharma, Nabriva, and Pfizer. Dr. Barbier received consulting and lecture fees from MSD and BioMérieux. Prof. Cortegiani received fees for lectures from Gilead, MSD, Pfizer; and he participated to advisory boards of MSD, Gilead, Pfizer. Dr. Montrucchio received fees for lectures from Gilead, Pfizer, Thermofisher; and she participated to advisory boards of Gilead. Dr. Conway Morris sits on the scientific advisory board of Cambridge Infection Diagnostics. Prof. Akova received grants from Pfizer and Gilead, had lecture fees paid to the institution by Pfizer and Sanofi. Dr. Ramanan acknowledges support from the Metro North Hospital and Health Services Clinician-Researcher Fellowship. Dr. Conway Morris sits on the scientific advisory board of Cambridge Infection Diagnostics. Dr. Conway Morris is supported by a Clinician Scientist Fellowship from the Medical Research Council (MR/V006118/1). Prof. José-Artur Paiva received fees for consulting, advisory boards or lectures from MSD, Pfizer, Astra-Zeneca, Gilead, Jansen, Cepheid, AOP Orphan Pharmaceuticals.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
Distribution of microorganisms between COVID-19 and non-COVID-19 patients in all HABSI and in ICU-acquired HABSI. HA-BSI hospital-acquired bloodstream infection, ICU intensive care unit, spp. species
Fig. 3
Fig. 3
Survival curves for all, ICU-acquired, enterococcal and DTR Gram-negative HABSI. ICU intensive care unit, HA-BSI hospital-acquired bloodstream infection, DTR difficult to treat resistance, Vs versus

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