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. 2020 Oct;50(10):e13319.
doi: 10.1111/eci.13319. Epub 2020 Aug 11.

Bloodstream infections in critically ill patients with COVID-19

Daniele Roberto Giacobbe  1   2 , Denise Battaglini  3 , Lorenzo Ball  3   4 , Iole Brunetti  3 , Bianca Bruzzone  5 , Giulia Codda  4 , Francesca Crea  6 , Andrea De Maria  1   2 , Chiara Dentone  1 , Antonio Di Biagio  1   2 , Giancarlo Icardi  2   5 , Laura Magnasco  1   2 , Anna Marchese  4   6 , Malgorzata Mikulska  1   2 , Andrea Orsi  2   5 , Nicolò Patroniti  3   4 , Chiara Robba  3 , Alessio Signori  2 , Lucia Taramasso  1   2 , Antonio Vena  1 , Paolo Pelosi  3   4 , Matteo Bassetti  1   2
Affiliations

Bloodstream infections in critically ill patients with COVID-19

Daniele Roberto Giacobbe et al. Eur J Clin Invest. 2020 Oct.

Abstract

Background: Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19).

Materials and methods: This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI.

Results: Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall P for the dummy variable = 0.003).

Conclusions: The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.

Keywords: BSI; COVID-19; SARS-CoV-2; coronavirus; steroid; tocilizumab.

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Conflict of interest statement

Outside the submitted work, DR Giacobbe reports honoraria from Stepstone Pharma GmbH and unconditional grants from MSD Italia and Correvio Italia. Outside the submitted work, M. Bassetti has received funding for scientific advisory boards, travel and speaker honoraria from Angelini, Astellas, AstraZeneca, Basilea, Bayer, BioMèrieux, Cidara, Correvio, Cubist, Menarini, Molteni, MSD, Nabriva, Paratek, Pfizer, Roche, Shionogi, Tetraphase, Thermo Fisher and The Medicine Company.

Figures

FIGURE 1
FIGURE 1
Cumulative risk of ICU‐acquired BSI in critically ill patients with COVID‐19. The cumulative risk of ICU‐acquired BSI in patients with COVID‐19 at different lengths of ICU stay was estimated using the Aalen‐Johansen method, with the first occurring ICU‐acquired BSI as the event of interest and death and discharge from the ICU as competing events. Right censoring was applied in the following cases: (a) persistent ICU stay at the end of the study period and (b) persistent ICU stay at day + 30 after the time of origin (defined as 48 h after ICU admission, see study methods). BSI, bloodstream infection; COVID‐19, coronavirus disease 2019; ICU, intensive care unit
FIGURE 2
FIGURE 2
Survival of ICU‐acquired BSI in critically ill patients with COVID‐19. Survival of first occurring ICU‐acquired BSI in patients with COVID‐19 was estimated using the Kaplan‐Meier method. Right censoring was applied in the following cases: (a) discharge from the ICU and (b) persistent ICU stay at the end of the study period. The maximum registered follow‐up was of 24 d after the time of origin. The time of origin was defined as the day when the first positive blood culture of the first occurring BSI episode was drawn. BSI, bloodstream infection; COVID‐19, coronavirus disease 2019; ICU, intensive care unit
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