Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors

Marco Ripa, Laura Galli, Andrea Poli, Chiara Oltolini, Vincenzo Spagnuolo, Andrea Mastrangelo, Camilla Muccini, Giacomo Monti, Giacomo De Luca, Giovanni Landoni, Lorenzo Dagna, Massimo Clementi, Patrizia Rovere Querini, Fabio Ciceri, Moreno Tresoldi, Adriano Lazzarin, Alberto Zangrillo, Paolo Scarpellini, Antonella Castagna, COVID-BioB study group, Andrea Andolina, Martina Baiardo Redaelli, Giorgia Bigai, Alba Bigoloni, Giorgia Borio, Simona Bossolasco, Elena Bruzzesi, Maria Grazia Calabrò, Stefania Calvisi, Corrado Campochiaro, Diana Canetti, Valentina Canti, Jacopo Castellani, Barbara Castiglioni, Giulio Cavalli, Ludovica Cavallo, Massimo Cernuschi, Matteo Chiurlo, Marta Cilla, Elena Cinel, Paola Cinque, Caterina Conte, Valentina Da Prat, Anna Danise, Rebecca De Lorenzo, Antonio Dell'Acqua, Raffaele Dell'Acqua, Emanuel Della Torre, Liviana Della Torre, Gaetano Di Terlizzi, Iulia Dumea, Federica Farolfi, Marica Ferrante, Claudia Frangi, Luca Fumagalli, Gabriele Gallina, Bruno Germinario, Nicola Gianotti, Monica Guffanti, Hamid Hasson, Francesca Lalla, Marco Lanzillotta, Raffaele Li Voti, Emanuela Messina, Chiara Molinari, Elena Moizo, Marco Montagna, Giulia Morsica, Silvia Nozza, Maria Pascali, Alessandro Patrizi, Marina Pieri, Antonella Poloniato, Dario Prestifilippo, Giuseppe Ramirez, Martina Ranzenigo, Jacopo Sapienza, Federico Seghi, Giuseppe Tambussi, Chiara Tassan Din, Stefano Turi, Caterina Uberti-Foppa, Concetta Vinci, Marco Ripa, Laura Galli, Andrea Poli, Chiara Oltolini, Vincenzo Spagnuolo, Andrea Mastrangelo, Camilla Muccini, Giacomo Monti, Giacomo De Luca, Giovanni Landoni, Lorenzo Dagna, Massimo Clementi, Patrizia Rovere Querini, Fabio Ciceri, Moreno Tresoldi, Adriano Lazzarin, Alberto Zangrillo, Paolo Scarpellini, Antonella Castagna, COVID-BioB study group, Andrea Andolina, Martina Baiardo Redaelli, Giorgia Bigai, Alba Bigoloni, Giorgia Borio, Simona Bossolasco, Elena Bruzzesi, Maria Grazia Calabrò, Stefania Calvisi, Corrado Campochiaro, Diana Canetti, Valentina Canti, Jacopo Castellani, Barbara Castiglioni, Giulio Cavalli, Ludovica Cavallo, Massimo Cernuschi, Matteo Chiurlo, Marta Cilla, Elena Cinel, Paola Cinque, Caterina Conte, Valentina Da Prat, Anna Danise, Rebecca De Lorenzo, Antonio Dell'Acqua, Raffaele Dell'Acqua, Emanuel Della Torre, Liviana Della Torre, Gaetano Di Terlizzi, Iulia Dumea, Federica Farolfi, Marica Ferrante, Claudia Frangi, Luca Fumagalli, Gabriele Gallina, Bruno Germinario, Nicola Gianotti, Monica Guffanti, Hamid Hasson, Francesca Lalla, Marco Lanzillotta, Raffaele Li Voti, Emanuela Messina, Chiara Molinari, Elena Moizo, Marco Montagna, Giulia Morsica, Silvia Nozza, Maria Pascali, Alessandro Patrizi, Marina Pieri, Antonella Poloniato, Dario Prestifilippo, Giuseppe Ramirez, Martina Ranzenigo, Jacopo Sapienza, Federico Seghi, Giuseppe Tambussi, Chiara Tassan Din, Stefano Turi, Caterina Uberti-Foppa, Concetta Vinci

Abstract

Objectives: The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19).

Methods: This was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366). We considered secondary bloodstream infections (BSIs) or possible lower respiratory tract infections (pLRTIs) occurring 48 hours after hospital admission until death or discharge. We calculated multivariable Fine-Gray models to assess factors associated with risk of secondary infections.

Results: Among 731 patients, a secondary infection was diagnosed in 68 patients (9.3%); 58/731 patients (7.9%) had at least one BSI and 22/731 patients (3.0%) at least one pLRTI. The overall 28-day cumulative incidence was 16.4% (95%CI 12.4-21.0%). Most of the BSIs were due to Gram-positive pathogens (76/106 isolates, 71.7%), specifically coagulase-negative staphylococci (53/76, 69.7%), while among Gram-negatives (23/106, 21.7%) Acinetobacter baumanii (7/23, 30.4%) and Escherichia coli (5/23, 21.7%) predominated. pLRTIs were caused mainly by Gram-negative pathogens (14/26, 53.8%). Eleven patients were diagnosed with putative invasive aspergillosis. At multivariable analysis, factors associated with secondary infections were low baseline lymphocyte count (≤0.7 versus >0.7 per 109/L, subdistribution hazard ratios (sdHRs) 1.93, 95%CI 1.11-3.35), baseline PaO2/FiO2 (per 100 points lower: sdHRs 1.56, 95%CI 1.21-2.04), and intensive-care unit (ICU) admission in the first 48 hours (sdHR 2.51, 95%CI 1.04-6.05).

Conclusions: Patients hospitalized with COVID-19 had a high incidence of secondary infections. At multivariable analysis, early need for ICU, respiratory failure, and severe lymphopenia were identified as risk factors for secondary infections.

Keywords: Bacterial infections; Bloodstream infections; COVID-19; Fungal infections; Lower respiratory tract infections; SARS-CoV-2; Secondary infections.

Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Flow-chart of study cohort. ∗Who gave consent to be recorded in the COVID-BioB database and to use their data.
Fig. 2
Fig. 2
Cumulative incidence of secondary infections of any type (panel A), according to baseline (BL) absolute lymphocyte count (panel B) and to BL PaO2/FiO2 (panel C).

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Source: PubMed

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