Secondary infections in critically ill patients with COVID-19: a retrospective single-center study

Abstract Background Patients infected with COVID-19 admitted to the intensive care unit may have a higher incidence of developing secondary infections. These infections can further deteriorate the hospital course and increase mortality. Therefore, the objectives of this study were to investigate the incidence, associated risk factors, outcomes, and pathogens associated with secondary bacterial infections in critically ill patients with COVID-19. Methods All adult COVID-19 patients admitted to the Intensive Care Unit requiring mechanical ventilation from 1st October 2020 until 31st December 2021 were screened for inclusion in the study. A total of 86 patients were screened, and 65 who met the inclusion criteria were prospectively entered into a customized electronic database. The database was then retrospectively analyzed to investigate secondary bacterial infections. 41.54% acquired at least one of the studied secondary bacterial infections during their ICU stay.. Results The most common secondary infection (59.26%) seen was hospital-acquired pneumonia followed by acquired bacteremia of unknown origin (25.92%), and catheter-related sepsis (14.81%). Diabetes mellitus (P = < 0.001), cumulative dose of corticosteroids (P = 0.001), and older age (P = < 0.001) were associated with an increased risk of secondary bacterial infection. The most commonly isolated pathogen in patients with secondary pneumonia was Acinetobacter baumannii. Staphylococcus aureus was the most common organism associated with a bloodstream infection or catheter-related sepsis. Conclusion Incidence of secondary bacterial/fungal infections was high in critically ill patients with COVID-19 and was associated with a longer duration of admission to the hospital and ICU and higher mortality. Age, a history of diabetes mellitus, and the administration of corticosteroids were associated with an increased risk of secondary bacterial infection.