Maria Antonia De Francesco, Liana Signorini, Simone Piva, Simone Pellizzeri, Benedetta Fumarola, Silvia Corbellini, Giorgio Piccinelli, Francesca Simonetti, Valentina Carta, Lucia Mangeri, Michela Padovani, Daniela Vecchiati, Nicola Latronico, Francesco Castelli, Arnaldo Caruso

Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS CoV‐2 infection than negative patients and are associated to a worse outcome

  • Infectious Diseases
  • Virology
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AbstractPatients with viral infections are at higher risk to acquire bacterial and fungal superinfections associated with a worse prognosis. We explored this critical point in the setting of patients with severe COVID‐19 disease. The study included 1911 patients admitted to intensive care unit (ICU) during a 2‐year study period (March 2020–March 2022). Of them, 713 (37.3%) were infected with SARS‐CoV‐2 and 1198 were negative (62.7%). Regression analysis was performed to determine risk factors associated with the presence of bacterial and/or fungal superinfections in SARS‐CoV‐2 patients and to evaluate predictors of ICU mortality. Of the 713 patients with SARS‐CoV‐2 infection, 473 (66.3%) had respiratory and/or bloodstream bacterial and/or fungal superinfections, while of the 1198 COVID‐19‐negative patients, only 369 (30%) showed respiratory and/or bloodstream bacterial and/or fungal superinfections (p < 0.0001). Baseline characteristics of COVID‐19 patients included a median age of 66 (interquartile range [IQR], 58–73), a predominance of males (72.7%), and the presence of a BMI higher than 24 (median 26; IQR, 24.5–30.4). Seventy‐four percent (527, 73.9%) had one or more comorbidities and 135 (18.9%) of them had received previous antibiotic therapy. Furthermore, most of them (473, 66.3%) exhibited severe radiological pictures and needed invasive mechanical ventilation. Multivariate logistic regression analysis showed that 1 unit increment in BMI rises the risk of bacterial and/or fungal superinfections acquisition by 3% and 1‐day increment in ICU stays rises the risk of bacterial and/or fungal superinfections acquisition by 11%. Furthermore, 1‐day increment in mechanical ventilation rises the risk of bacterial and/or fungal superinfection acquisition by 2.7 times. Furthermore, patients with both bacterial and fungal infections had a significantly higher mortality rate than patients without superinfections (45.8% vs. 26.2%, p < 0.0001). Therefore, bacterial and fungal superinfections are frequent in COVID‐19 patients admitted to ICU and their presence is associated with a worse outcome. This is an important consideration for targeted therapies in critically ill SARS‐CoV‐2 infected patients to improve their clinical course.

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