@article{3347515,
    title = "Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set",
    author = "Conway Morris, A. and Kohler, K. and De Corte, T. and Ercole, A. and De Grooth, H.-J. and Elbers, P.W.G. and Povoa, P. and Morais, R. and Koulenti, D. and Jog, S. and Nielsen, N. and Jubb, A. and Cecconi, M. and De Waele, J. and Bezzi, M. and Gira, A. and Eller, P. and Hamid, T. and Haque, I.U. and De Buyser, W. and Cudia, A. and De Backer, D. and Foulon, P. and Collin, V. and Van Hecke, J. and De Waele, E. and Van Malderen, C. and Mesland, J.-B. and Piagnerelli, M. and Haentjens, L. and De Schryver, N. and Van Leemput, J. and Vanhove, P. and Bulpa, P. and Ilieva, V. and Katz, D. and Geagea, A. and Binnie, A. and Tirapegui, F. and Lago, G. and Graf, J. and Perez-Araos, R. and Vargas, P. and Martinez, F. and Labarca, E. and Franco, D.M. and Parra-Tanoux, D. and Reyes, L.F. and Yepes, D. and Periš, F. and Stipic, S.S. and Burgos, C.V.C. and Boada, P.R.N. and Brun, J.L.B. and Ballesteros, J.P.P. and Hammouda, A. and Elmandouh, O. and Azzam, A. and Hussein, A.M. and Galal, I. and Awad, A.K. and Azab, M.A. and Abdalla, M. and Assal, H. and Alfishawy, M. and Ghozy, S. and Tharwat, S. and Eldaly, A. and Reinhard, V. and Chrisment, A. and Poyat, C. and Badie, J. and Ferrari, F.B. and Weiss, B. and Kuhn, K.F. and Grunow, J.J. and Lorenz, M. and Schaller, S. and Spieth, P. and Bota, M. and Fichtner, F. and Fuest, K. and Lahmer, T. and Herrmann, J. and Meybohm, P. and Markou, N. and Vasileiadou, G. and Chrysanthopoulou, E. and Papamichalis, P. and Soultati, I. and Kalvit, K. and Myatra, S.N. and Krupa, I. and Tharwat, A. and Nichol, A. and McCarthy, A. and Mahmoodpoor, A. and Tonetti, T. and Isoni, P. and Spadaro, S. and Volta, C.A. and Mirabella, L. and Noto, A. and Florio, G. and Guzzardella, A. and Paleari, C. and Baccanelli, F. and Savi, M. and Antonelli, M. and Vaccarini, B. and Montrucchio, G. and Sales, G. and Donadello, K. and Gottin, L. and Polati, E. and De Rosa, S. and Sulemanji, D. and Abusalama, A. and Elhadi, M. and De Jesus, M.F. and Gonzalez, D.R. and Canedo, N. and Chavez, A.E. and Dendane, T. and Grady, B. and de Jong, B. and van der Heiden, E. and Thoral, P. and van den Bogaard, B. and Spronk, P.E. and Achterberg, S. and Groeneveld, M. and So, R.K.L. and de Wijs, C. and Scholten, H. and Beishuizen, A. and Cornet, A.D. and Reidinga, A.C. and Kranen, H. and Mensink, R. and Boer, S. and de Groot, M. and Beck, O. and Bethlehem, C. and van Bussel, B. and Frenzel, T. and de Jong, C. and Wilting, R. and Kesecioglu, J. and Mehagnoul-Schipper, J. and Alasia, D. and Kumar, A. and Qayyum, A. and Rana, M. and Jayyab, M.A. and Sierra, R.Q. and Hernandez, A.M. and Taborda, L. and Ramires, T. and Silva, C. and Roriz, C. and Patricio, P. and Santos, M.L. and Costa, V. and Cunha, P. and Gonçalves, C. and Nunes, S. and Camões, J. and Adrião, D. and Oliveira, A. and Omrani, A. and Al Maslamani, M. and elbuzidi, A.S. and Al qudah, B.M. and Akkari, A.R. and Alkhatteb, M. and Baiou, A. and Husain, A. and Alwraidat, M. and Saif, I.A. and Bakdach, D. and Ahmed, A. and Aleef, M. and Bintaher, A. and Petrisor, C. and Popov, E. and Popova, K. and Dementienko, M. and Teplykh, B. and Pyregov, A. and Davydova, L. and Vladislav, B. and Neporada, E. and Zverev, I. and Meshchaninova, S. and Sokolov, D. and Gavrilova, E. and Shlyk, I. and Poliakov, I. and B?aco?a, M. and Aljuhani, O. and Alkhalaf, A. and Humaid, F.B. and Arabi, Y. and Kuhail, A. and Elrabi, O. and Alghnam, M. and Kansal, A. and Ho, V.K. and Ng, J. and García, R.R. and Fraga, X.T. and del Pilar García-Bonillo, M. and Padilla-Serrano, A. and Cuadrado, M.M. and Ferrando, C. and Catalan-Monzon, I. and Galarza, L. and Frutos-Vivar, F. and Jimenez, J. and Rodríguez-Solis, C. and Franquesa-Gonzalez, E. and Acosta, G.P. and Cabrera, L.S. and Parra, J.P.A. and Gonzalez, F.M. and del Carmen Lorente Conesa, M. and Varela, I.Y.M. and Pravia, O.V.B. and Delgado, M.C.M. and de Cabo, C.M. and Ioan, A.-M. and Perez-Calvo, C. and Santos, A. and Abad-Motos, A. and Ripolles-Melchor, J. and Martin, B.C. and Teruel, S.Y. and Lucas, J.H. and Ortiz, A.B. and de Pablo Sánchez, R. and Barrueco-Francioni, J.E. and Espina, L.F. and Bonell-Goytisolo, J.M. and Salaverria, I. and Mir, A.S. and Rodriguez-Ruiz, E. and Valverde, V.H. and Cubero, P.J. and Linde, F.A. and Leganes, N.C. and Romeu, J.M. and Concha, P. and Berezo-Garcia, J.A. and Fraile, V. and Cuenca-Rubio, C. and Perez-Torres, D. and Serrano, A. and Valero, C.M. and Suner, A.O. and Larrañaga, L. and Legaristi, N. and Ferrigno, G. and Khlafalla, S. and Bihariesingh-Sanchit, R. and Zoerner, F. and Grip, J. and Kilsand, K. and Österlind, J. and von Seth, M. and Berkius, J. and Ceruti, S. and Glotta, A. and Izdes, S. and Turan, I.Ö. and Cosar, A. and Halacli, B. and Dereli, N. and Yilmaz, M. and Akbas, T. and Elay, G. and Eyüpoglu, S. and Bílír, Y. and Saraçoglu, K.T. and Kaya, E. and Sahin, A.S. and Ekren, P.K. and Mengi, T. and Suner, K.O. and Tomak, Y. and Eroglu, A. and Alsabbah, A. and Hanlon, K. and Gervin, K. and McMahon, S. and Hagan, S. and Higenbottam, C.V. and Mullhi, R. and Poulton, L. and Torlinski, T. and Gareth, A. and Truman, N. and Vijayakumar, G. and Hall, C. and Cagova, L. and Jones, N. and Graham, S. and Robin, N. and Cowton, A. and Donnelly, A. and Singatullina, N. and Kent, M. and Boulanger, C. and Campbell, Z. and Potter, E. and Duric, N. and Szakmany, T. and Kviatkovske, O. and Marczin, N. and Ellis, C. and Saha, R. and Sri-Chandana, C. and Allan, J. and Mumelj, L. and Venkatesh, H. and Gotz, V.N. and Cochrane, A. and Lumlertgul, N. and Ficial, B. and Jain, S. and Crapelli, G.B. and Vlachou, A. and Golden, D. and Garrioch, S. and Henning, J. and Loveleena, G. and Davey, M. and Grauslyte, L. and Salciute-Simene, E. and Cook, M. and Barling, D. and Broadhurst, P. and Purvis, S. and Michael, S. and Shuker, B. and Grecu, I. and Harding, D. and Singatullina, N. and Dean, J.T. and Nielsen, N.D. and Al-Bayati, S. and Al-Sadawi, M. and Charron, M. and Stubenrauch, P. and Santanilla, J. and Wentowski, C. and Rosenberger, D. and Eksarko, P. and Jawa, R. and for the ESICM UNITE COVID investigators",
    journal = "Critical care explorations",
    year = "2022",
    volume = "26",
    number = "1",
    publisher = "BioMed Central Ltd.",
    doi = "10.1186/s13054-022-04108-8",
    keywords = "antibiotic agent;  corticosteroid;  antiinfective agent, adult;  aged;  antibiotic therapy;  Article;  bacterial pneumonia;  cohort analysis;  coinfection;  confounding variable;  controlled study;  coronavirus disease 2019;  critically ill patient;  disease surveillance;  drug use;  female;  hospital admission;  hospital infection;  human;  intensive care unit;  long term care;  lung mycosis;  major clinical study;  male;  observational study;  pandemic;  polymerase chain reaction;  treatment duration;  bacterial pneumonia;  clinical trial;  coinfection;  complication;  critical illness;  intensive care unit;  multicenter study;  virus pneumonia, Adrenal Cortex Hormones;  Adult;  Anti-Bacterial Agents;  Coinfection;  COVID-19;  COVID-19 Testing;  Critical Illness;  Humans;  Intensive Care Units;  Pandemics;  Pneumonia, Bacterial;  Pneumonia, Viral",
    abstract = "Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract: [Figure not available: see fulltext.]. © 2022, The Author(s)."
}