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. 2022 Mar;17(2):431-438.
doi: 10.1007/s11739-021-02824-7. Epub 2021 Aug 18.

Bacterial infections in patients hospitalized with COVID-19

Víctor Moreno-Torres  1 , Carmen de Mendoza  2   3 , Sara de la Fuente  4 , Enrique Sánchez  4 , María Martínez-Urbistondo  4 , Jesús Herráiz  4 , Andrea Gutiérrez  4 , Ángela Gutiérrez  4 , Carlos Hernández  5 , Alejandro Callejas  4 , Carmen Maínez  4 , Ana Royuela  6 , Valentín Cuervas-Mons  4   7 ; Puerta de Hierro COVID-19 working group
Collaborators, Affiliations

Bacterial infections in patients hospitalized with COVID-19

Víctor Moreno-Torres et al. Intern Emerg Med. 2022 Mar.

Abstract

Bacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.

Keywords: Bacterial infections; COVID-19 pneumonia; Steroids.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Predictors of mortality in COVID-19 hospitalized patients. Odds ratio are represented by squares and the lines correspond to 95% confidence interval. CI Confidence interval, ARDS Acute respiratory distress syndrome, ICU Intensive care Unit
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Comment in

  • Use of antibiotics in respiratory viral infections.
    Fernández-Montero JV, Corral O, Barreiro P, Soriano V. Fernández-Montero JV, et al. Intern Emerg Med. 2022 Sep;17(6):1569-1570. doi: 10.1007/s11739-022-02957-3. Epub 2022 Mar 17. Intern Emerg Med. 2022. PMID: 35298781 Free PMC article. No abstract available.

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