Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome

Eur J Clin Microbiol Infect Dis. 2021 Mar;40(3):495-502. doi: 10.1007/s10096-020-04142-w. Epub 2021 Jan 3.


Bacterial and fungal co-infection has been reported in patients with COVID-19, but there is limited experience on these infections in critically ill patients. The objective of this study was to assess the characteristics and ouctome of ICU-acquired infections in COVID-19 patients. We conducted a retrospective single-centre, case-control study including 140 patients with severe COVID-19 admitted to the ICU between March and May 2020. We evaluated the epidemiological, clinical, and microbiological features, and outcome of ICU-acquired infections. Fifty-seven patients (40.7%) developed a bacterial or fungal nosocomial infection during ICU stay. Infection occurred after a median of 9 days (IQR 5-11) of admission and was significantly associated with the APACHE II score (p = 0.02). There were 91 episodes of infection: primary (31%) and catheter-related (25%) bloodstream infections were the most frequent, followed by pneumonia (23%), tracheobronchitis (10%), and urinary tract infection (8%) that were produced by a wide spectrum of Gram-positive (55%) and Gram-negative bacteria (30%) as well as fungi (15%). In 60% of cases, infection was associated with septic shock and a significant increase in SOFA score. Overall ICU mortality was 36% (51/140). Infection was significantly associated with death (OR 2.7, 95% CI 1.2-5.9, p = 0.015) and a longer ICU stay (p < 0.001). Bacterial and fungal nosocomial infection is a common complication of ICU admission in patients with COVID-19. It usually presents as a severe form of infection, and it is associated with a high mortality and longer course of ICU stay.

Keywords: COVID-19; Intensive care; Nosocomial infection; Outcome; SARS-CoV-2.

MeSH terms

  • Aged
  • Bacteria / classification
  • Bacteria / isolation & purification
  • COVID-19 / epidemiology*
  • COVID-19 / microbiology
  • COVID-19 / pathology
  • Case-Control Studies
  • Critical Illness
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Cross Infection / mortality
  • Cross Infection / pathology
  • Female
  • Fungi / classification
  • Fungi / isolation & purification
  • Hospital Mortality
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Length of Stay
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2