1. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors
- Author
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Raffaele Li Voti, Massimo Clementi, Barbara Castiglioni, Maria Grazia Calabrò, Alberto Zangrillo, Hamid Hasson, Valentina Da Prat, Anna Danise, Ludovica Cavallo, Valentina Canti, Chiara Molinari, Alba Bigoloni, Antonio Dell'Acqua, Giovanni Landoni, Raffaele Dell’Acqua, Francesca Lalla, Patrizia Rovere Querini, Simona Bossolasco, Adriano Lazzarin, Rebecca De Lorenzo, Alessandro Patrizi, Vincenzo Spagnuolo, Paola Cinque, Jacopo Castellani, Paolo Scarpellini, Marica Ferrante, Marco Ripa, Giacomo Monti, Caterina Uberti-Foppa, Emanuel Della Torre, Antonella Castagna, Giorgia Borio, Martina Ranzenigo, Federico Seghi, Bruno Germinario, Giorgia Bigai, Giacomo De Luca, Corrado Campochiaro, Giulio Cavalli, Giulia Morsica, Liviana Della Torre, Marta Cilla, Gabriele Gallina, Fabio Ciceri, Gaetano Di Terlizzi, Nicola Gianotti, Maria Pascali, Silvia Nozza, Marina Pieri, Giuseppe Tambussi, Andrea Andolina, Caterina Conte, Federica Farolfi, Luca Fumagalli, Andrea Poli, Elena Cinel, Monica Guffanti, Moreno Tresoldi, Camilla Muccini, Lorenzo Dagna, Chiara Oltolini, Marco Montagna, Dario Prestifilippo, Concetta Vinci, Emanuela Messina, Diana Canetti, Elena Bruzzesi, Laura Galli, Martina Baiardo Redaelli, Jacopo Sapienza, Iulia Dumea, Elena Moizo, Matteo Chiurlo, Chiara Tassan Din, Stefania Calvisi, Stefano Turi, Massimo Cernuschi, Marco Lanzillotta, Antonella Poloniato, Giuseppe A. Ramirez, Claudia Frangi, Andrea Mastrangelo, Ripa, M., Galli, L., Poli, A., Oltolini, C., Spagnuolo, V., Mastrangelo, A., Muccini, C., Monti, G., De Luca, G., Landoni, G., Dagna, L., Clementi, M., Rovere Querini, P., Ciceri, F., Tresoldi, M., Lazzarin, A., Zangrillo, A., Scarpellini, P., Castagna, A., Andolina, A., Redaelli, M. B., Bigai, G., Bigoloni, A., Borio, G., Bossolasco, S., Bruzzesi, E., Calabro, M. G., Calvisi, S., Campochiaro, C., Canetti, D., Canti, V., Castellani, J., Castiglioni, B., Cavalli, G., Cavallo, L., Cernuschi, M., Chiurlo, M., Cilla, M., Cinel, E., Cinque, P., Conte, C., Da Prat, V., Danise, A., De Lorenzo, R., Dell'Acqua, A., Dell'Acqua, R., Della Torre, E., Della Torre, L., Di Terlizzi, G., Dumea, I., Farolfi, F., Ferrante, M., Frangi, C., Fumagalli, L., Gallina, G., Germinario, B., Gianotti, N., Guffanti, M., Hasson, H., Lalla, F., Lanzillotta, M., Li Voti, R., Messina, E., Molinari, C., Moizo, E., Montagna, M., Morsica, G., Nozza, S., Pascali, M., Patrizi, A., Pieri, M., Poloniato, A., Prestifilippo, D., Ramirez, G., Ranzenigo, M., Sapienza, J., Seghi, F., Tambussi, G., Tassan Din, C., Turi, S., Uberti-Foppa, C., and Vinci, C.
- Subjects
0301 basic medicine ,Microbiology (medical) ,Male ,medicine.medical_specialty ,Secondary infection ,030106 microbiology ,Aspergillosis ,Cohort Studies ,Fungal infections ,03 medical and health sciences ,0302 clinical medicine ,Bacterial infections ,Risk Factors ,Internal medicine ,Sepsis ,Medicine ,Humans ,Cumulative incidence ,030212 general & internal medicine ,Secondary infections ,Respiratory Tract Infections ,Aged ,Respiratory tract infections ,biology ,business.industry ,Coinfection ,SARS-CoV-2 ,Incidence (epidemiology) ,Incidence ,COVID-19 ,General Medicine ,Acinetobacter ,Middle Aged ,medicine.disease ,biology.organism_classification ,Lower respiratory tract infections ,Hospitalization ,Infectious Diseases ,Respiratory failure ,Italy ,Original Article ,Female ,Bloodstream infections ,business ,Cohort study - Abstract
Objectives The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19). Methods This was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366). We considered secondary bloodstream infections (BSIs) or possible lower respiratory tract infections (pLRTIs) occurring 48 hours after hospital admission until death or discharge. We calculated multivariable Fine–Gray models to assess factors associated with risk of secondary infections. Results Among 731 patients, a secondary infection was diagnosed in 68 patients (9.3%); 58/731 patients (7.9%) had at least one BSI and 22/731 patients (3.0%) at least one pLRTI. The overall 28-day cumulative incidence was 16.4% (95%CI 12.4–21.0%). Most of the BSIs were due to Gram-positive pathogens (76/106 isolates, 71.7%), specifically coagulase-negative staphylococci (53/76, 69.7%), while among Gram-negatives (23/106, 21.7%) Acinetobacter baumanii (7/23, 30.4%) and Escherichia coli (5/23, 21.7%) predominated. pLRTIs were caused mainly by Gram-negative pathogens (14/26, 53.8%). Eleven patients were diagnosed with putative invasive aspergillosis. At multivariable analysis, factors associated with secondary infections were low baseline lymphocyte count (≤0.7 versus >0.7 per 109/L, subdistribution hazard ratios (sdHRs) 1.93, 95%CI 1.11–3.35), baseline PaO2/FiO2 (per 100 points lower: sdHRs 1.56, 95%CI 1.21–2.04), and intensive-care unit (ICU) admission in the first 48 hours (sdHR 2.51, 95%CI 1.04–6.05). Conclusions Patients hospitalized with COVID-19 had a high incidence of secondary infections. At multivariable analysis, early need for ICU, respiratory failure, and severe lymphopenia were identified as risk factors for secondary infections.
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- 2020