Risks and features of secondary infections in severe and critical ill COVID-19 patients

Emerg Microbes Infect. 2020 Dec;9(1):1958-1964. doi: 10.1080/22221751.2020.1812437.

Abstract

Objectives Severe or critical COVID-19 is associated with intensive care unit admission, increased secondary infection rate, and would lead to significant worsened prognosis. Risks and characteristics relating to secondary infections in severe COVID-19 have not been described. Methods Severe and critical COVID-19 patients from Shanghai were included. We collected lower respiratory, urine, catheters, and blood samples according to clinical necessity and culture and mNGS were performed. Clinical and laboratory data were archived. Results We found 57.89% (22/38) patients developed secondary infections. The patient receiving invasive mechanical ventilation or in critical state has a higher chance of secondary infections (P<0.0001). The most common infections were respiratory, blood-stream and urinary infections, and in respiratory infections, the most detected pathogens were gram-negative bacteria (26, 50.00%), following by gram-positive bacteria (14, 26.92%), virus (6, 11.54%), fungi (4, 7.69%), and others (2, 3.85%). Respiratory Infection rate post high flow, tracheal intubation, and tracheotomy were 12.90% (4/31), 30.43% (7/23), and 92.31% (12/13) respectively. Secondary infections would lead to lower discharge rate and higher mortality rate. Conclusion Our study originally illustrated secondary infection proportion in severe and critical COVID-19 patients. Culture accompanied with metagenomics sequencing increased pathogen diagnostic rate. Secondary infections risks increased after receiving invasive respiratory ventilations and intravascular devices, and would lead to a lower discharge rate and a higher mortality rate.

Keywords: COVID-19; SARS-CoV-2; intensive care; intravascular devices; respiratory ventilations; secondary infection.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Bacteremia / microbiology
  • Bacteremia / mortality
  • Bacteremia / pathology*
  • Bacteremia / virology
  • Bacterial Infections / microbiology
  • Bacterial Infections / mortality
  • Bacterial Infections / pathology*
  • Bacterial Infections / virology
  • Betacoronavirus / pathogenicity
  • Coronavirus Infections / microbiology
  • Coronavirus Infections / mortality
  • Coronavirus Infections / pathology*
  • Coronavirus Infections / virology
  • Critical Illness
  • Female
  • Fungemia / microbiology
  • Fungemia / mortality
  • Fungemia / pathology*
  • Fungemia / virology
  • Fungi / pathogenicity
  • Gram-Negative Bacteria / pathogenicity
  • Gram-Positive Bacteria / pathogenicity
  • Humans
  • Intensive Care Units
  • Lung / microbiology
  • Lung / pathology
  • Lung / virology
  • Male
  • Middle Aged
  • Mycoses / microbiology
  • Mycoses / mortality
  • Mycoses / pathology*
  • Mycoses / virology
  • Opportunistic Infections / microbiology
  • Opportunistic Infections / mortality
  • Opportunistic Infections / pathology*
  • Opportunistic Infections / virology
  • Pandemics
  • Pneumonia, Viral / microbiology
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / pathology*
  • Pneumonia, Viral / virology
  • Respiration, Artificial / adverse effects
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / mortality
  • Respiratory Tract Infections / pathology*
  • Respiratory Tract Infections / virology
  • Retrospective Studies
  • Risk
  • Severity of Illness Index
  • Survival Analysis
  • Urinary Tract Infections / microbiology
  • Urinary Tract Infections / mortality
  • Urinary Tract Infections / pathology*
  • Urinary Tract Infections / virology

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2