Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors
The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19). This was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366)...
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| Veröffentlicht in: | Clinical microbiology and infection 2021-03, Vol.27 (3), p.451-457 |
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| creator | Ripa, Marco Galli, Laura Poli, Andrea Oltolini, Chiara Spagnuolo, Vincenzo Mastrangelo, Andrea Muccini, Camilla Monti, Giacomo De Luca, Giacomo Landoni, Giovanni Dagna, Lorenzo Clementi, Massimo Rovere Querini, Patrizia Ciceri, Fabio Tresoldi, Moreno Lazzarin, Adriano Zangrillo, Alberto Scarpellini, Paolo Castagna, Antonella Andolina, Andrea Redaelli, Martina Baiardo Bigai, Giorgia Bigoloni, Alba Borio, Giorgia Bossolasco, Simona Bruzzesi, Elena Calabrò, Maria Grazia Calvisi, Stefania Campochiaro, Corrado Canetti, Diana Canti, Valentina Castellani, Jacopo Castiglioni, Barbara Cavalli, Giulio Cavallo, Ludovica Cernuschi, Massimo Chiurlo, Matteo Cilla, Marta Cinel, Elena Cinque, Paola Conte, Caterina Da Prat, Valentina Danise, Anna De Lorenzo, Rebecca Dell’Acqua, Antonio Dell’Acqua, Raffaele Della Torre, Emanuel Della Torre, Liviana Di Terlizzi, Gaetano Dumea, Iulia Farolfi, Federica Ferrante, Marica Frangi, Claudia Fumagalli, Luca Gallina, Gabriele Germinario, Bruno Gianotti, Nicola Guffanti, Monica Hasson, Hamid Lalla, Francesca Lanzillotta, Marco Li Voti, Raffaele Messina, Emanuela Molinari, Chiara Moizo, Elena Montagna, Marco Morsica, Giulia Nozza, Silvia Pascali, Maria Patrizi, Alessandro Pieri, Marina Poloniato, Antonella Prestifilippo, Dario Ramirez, Giuseppe Ranzenigo, Martina Sapienza, Jacopo Seghi, Federico Tambussi, Giuseppe Tassan Din, Chiara Turi, Stefano Uberti-Foppa, Caterina Vinci, Concetta |
| description | The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19).
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.
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).
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. |
| doi_str_mv | 10.1016/j.cmi.2020.10.021 |
| format | Article |
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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.
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).
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.</description><identifier>ISSN: 1198-743X</identifier><identifier>EISSN: 1469-0691</identifier><identifier>DOI: 10.1016/j.cmi.2020.10.021</identifier><identifier>PMID: 33223114</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Bacterial infections ; Bloodstream infections ; Cohort Studies ; Coinfection - epidemiology ; Coinfection - microbiology ; COVID-19 ; COVID-19 - epidemiology ; Female ; Fungal infections ; Hospitalization - statistics & numerical data ; Humans ; Incidence ; Italy - epidemiology ; Lower respiratory tract infections ; Male ; Middle Aged ; Original ; Respiratory Tract Infections - epidemiology ; Respiratory Tract Infections - microbiology ; Risk Factors ; SARS-CoV-2 ; Secondary infections ; Sepsis - epidemiology ; Sepsis - etiology ; Sepsis - microbiology</subject><ispartof>Clinical microbiology and infection, 2021-03, Vol.27 (3), p.451-457</ispartof><rights>2020 European Society of Clinical Microbiology and Infectious Diseases</rights><rights>Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.</rights><rights>2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. 2020 European Society of Clinical Microbiology and Infectious Diseases</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-91a3e01249dfa4edbb43261e56ce6138f2c943ddd75d500be65cc6ef2a5bd3d23</citedby><cites>FETCH-LOGICAL-c451t-91a3e01249dfa4edbb43261e56ce6138f2c943ddd75d500be65cc6ef2a5bd3d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33223114$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ripa, Marco</creatorcontrib><creatorcontrib>Galli, Laura</creatorcontrib><creatorcontrib>Poli, Andrea</creatorcontrib><creatorcontrib>Oltolini, Chiara</creatorcontrib><creatorcontrib>Spagnuolo, Vincenzo</creatorcontrib><creatorcontrib>Mastrangelo, Andrea</creatorcontrib><creatorcontrib>Muccini, Camilla</creatorcontrib><creatorcontrib>Monti, Giacomo</creatorcontrib><creatorcontrib>De Luca, Giacomo</creatorcontrib><creatorcontrib>Landoni, Giovanni</creatorcontrib><creatorcontrib>Dagna, Lorenzo</creatorcontrib><creatorcontrib>Clementi, Massimo</creatorcontrib><creatorcontrib>Rovere Querini, Patrizia</creatorcontrib><creatorcontrib>Ciceri, Fabio</creatorcontrib><creatorcontrib>Tresoldi, Moreno</creatorcontrib><creatorcontrib>Lazzarin, Adriano</creatorcontrib><creatorcontrib>Zangrillo, Alberto</creatorcontrib><creatorcontrib>Scarpellini, Paolo</creatorcontrib><creatorcontrib>Castagna, Antonella</creatorcontrib><creatorcontrib>Andolina, Andrea</creatorcontrib><creatorcontrib>Redaelli, Martina Baiardo</creatorcontrib><creatorcontrib>Bigai, Giorgia</creatorcontrib><creatorcontrib>Bigoloni, Alba</creatorcontrib><creatorcontrib>Borio, Giorgia</creatorcontrib><creatorcontrib>Bossolasco, Simona</creatorcontrib><creatorcontrib>Bruzzesi, Elena</creatorcontrib><creatorcontrib>Calabrò, Maria Grazia</creatorcontrib><creatorcontrib>Calvisi, Stefania</creatorcontrib><creatorcontrib>Campochiaro, Corrado</creatorcontrib><creatorcontrib>Canetti, Diana</creatorcontrib><creatorcontrib>Canti, Valentina</creatorcontrib><creatorcontrib>Castellani, Jacopo</creatorcontrib><creatorcontrib>Castiglioni, Barbara</creatorcontrib><creatorcontrib>Cavalli, Giulio</creatorcontrib><creatorcontrib>Cavallo, Ludovica</creatorcontrib><creatorcontrib>Cernuschi, Massimo</creatorcontrib><creatorcontrib>Chiurlo, Matteo</creatorcontrib><creatorcontrib>Cilla, Marta</creatorcontrib><creatorcontrib>Cinel, Elena</creatorcontrib><creatorcontrib>Cinque, Paola</creatorcontrib><creatorcontrib>Conte, Caterina</creatorcontrib><creatorcontrib>Da Prat, Valentina</creatorcontrib><creatorcontrib>Danise, Anna</creatorcontrib><creatorcontrib>De Lorenzo, Rebecca</creatorcontrib><creatorcontrib>Dell’Acqua, Antonio</creatorcontrib><creatorcontrib>Dell’Acqua, Raffaele</creatorcontrib><creatorcontrib>Della Torre, Emanuel</creatorcontrib><creatorcontrib>Della Torre, Liviana</creatorcontrib><creatorcontrib>Di Terlizzi, Gaetano</creatorcontrib><creatorcontrib>Dumea, Iulia</creatorcontrib><creatorcontrib>Farolfi, Federica</creatorcontrib><creatorcontrib>Ferrante, Marica</creatorcontrib><creatorcontrib>Frangi, Claudia</creatorcontrib><creatorcontrib>Fumagalli, Luca</creatorcontrib><creatorcontrib>Gallina, Gabriele</creatorcontrib><creatorcontrib>Germinario, Bruno</creatorcontrib><creatorcontrib>Gianotti, Nicola</creatorcontrib><creatorcontrib>Guffanti, Monica</creatorcontrib><creatorcontrib>Hasson, Hamid</creatorcontrib><creatorcontrib>Lalla, Francesca</creatorcontrib><creatorcontrib>Lanzillotta, Marco</creatorcontrib><creatorcontrib>Li Voti, Raffaele</creatorcontrib><creatorcontrib>Messina, Emanuela</creatorcontrib><creatorcontrib>Molinari, Chiara</creatorcontrib><creatorcontrib>Moizo, Elena</creatorcontrib><creatorcontrib>Montagna, Marco</creatorcontrib><creatorcontrib>Morsica, Giulia</creatorcontrib><creatorcontrib>Nozza, Silvia</creatorcontrib><creatorcontrib>Pascali, Maria</creatorcontrib><creatorcontrib>Patrizi, Alessandro</creatorcontrib><creatorcontrib>Pieri, Marina</creatorcontrib><creatorcontrib>Poloniato, Antonella</creatorcontrib><creatorcontrib>Prestifilippo, Dario</creatorcontrib><creatorcontrib>Ramirez, Giuseppe</creatorcontrib><creatorcontrib>Ranzenigo, Martina</creatorcontrib><creatorcontrib>Sapienza, Jacopo</creatorcontrib><creatorcontrib>Seghi, Federico</creatorcontrib><creatorcontrib>Tambussi, Giuseppe</creatorcontrib><creatorcontrib>Tassan Din, Chiara</creatorcontrib><creatorcontrib>Turi, Stefano</creatorcontrib><creatorcontrib>Uberti-Foppa, Caterina</creatorcontrib><creatorcontrib>Vinci, Concetta</creatorcontrib><creatorcontrib>COVID-BioB study group</creatorcontrib><title>Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors</title><title>Clinical microbiology and infection</title><addtitle>Clin Microbiol Infect</addtitle><description>The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19).
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.
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).
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.</description><subject>Aged</subject><subject>Bacterial infections</subject><subject>Bloodstream infections</subject><subject>Cohort Studies</subject><subject>Coinfection - epidemiology</subject><subject>Coinfection - microbiology</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>Female</subject><subject>Fungal infections</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Incidence</subject><subject>Italy - epidemiology</subject><subject>Lower respiratory tract infections</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Respiratory Tract Infections - epidemiology</subject><subject>Respiratory Tract Infections - microbiology</subject><subject>Risk Factors</subject><subject>SARS-CoV-2</subject><subject>Secondary infections</subject><subject>Sepsis - epidemiology</subject><subject>Sepsis - etiology</subject><subject>Sepsis - microbiology</subject><issn>1198-743X</issn><issn>1469-0691</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhq0KREvhB_SCcuSSxWM73k2RkNCWj0qVeoBWXJDl2BN2Vtk42Nmt2l-Po22rcunJY887r2fmYewE-Aw46A_rmdvQTHAx3WdcwAE7AqXrkusaXuQY6kU5V_LXIXud0ppzLqRUr9ihlEJIAHXEfv9AF3pv421BfYtupNCnHBaDHQn7MRWrkAYabUd36IsbGlfF8vL6_KyE-jTrHHnsHRa298UQ0VN22GHRWjeGmN6wl63tEr69P4_Z1dcvP5ffy4vLb-fLzxelUxWMZQ1WIgehat9ahb5plBQasNIONchFK1ytpPd-XvmK8wZ15ZzGVtiq8dILecw-7X2HbbNB73Lj0XZmiLTJk5lgyfyf6Wll_oSdmVcLpWqdDd7fG8Twd4tpNBtKDrvO9hi2yQilpeYLIVSWwl7qYkgpYvv4DXAzYTFrk7GYCcv0lLHkmndP-3useOCQBR_3Asxb2hFGkxxNi_UUMxTjAz1j_w-hUp-3</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Ripa, Marco</creator><creator>Galli, Laura</creator><creator>Poli, Andrea</creator><creator>Oltolini, Chiara</creator><creator>Spagnuolo, Vincenzo</creator><creator>Mastrangelo, Andrea</creator><creator>Muccini, Camilla</creator><creator>Monti, Giacomo</creator><creator>De Luca, Giacomo</creator><creator>Landoni, Giovanni</creator><creator>Dagna, Lorenzo</creator><creator>Clementi, Massimo</creator><creator>Rovere Querini, Patrizia</creator><creator>Ciceri, Fabio</creator><creator>Tresoldi, Moreno</creator><creator>Lazzarin, Adriano</creator><creator>Zangrillo, Alberto</creator><creator>Scarpellini, Paolo</creator><creator>Castagna, Antonella</creator><creator>Andolina, Andrea</creator><creator>Redaelli, Martina Baiardo</creator><creator>Bigai, Giorgia</creator><creator>Bigoloni, Alba</creator><creator>Borio, Giorgia</creator><creator>Bossolasco, Simona</creator><creator>Bruzzesi, Elena</creator><creator>Calabrò, Maria Grazia</creator><creator>Calvisi, Stefania</creator><creator>Campochiaro, Corrado</creator><creator>Canetti, Diana</creator><creator>Canti, Valentina</creator><creator>Castellani, Jacopo</creator><creator>Castiglioni, Barbara</creator><creator>Cavalli, Giulio</creator><creator>Cavallo, Ludovica</creator><creator>Cernuschi, Massimo</creator><creator>Chiurlo, Matteo</creator><creator>Cilla, Marta</creator><creator>Cinel, Elena</creator><creator>Cinque, Paola</creator><creator>Conte, Caterina</creator><creator>Da Prat, Valentina</creator><creator>Danise, Anna</creator><creator>De Lorenzo, Rebecca</creator><creator>Dell’Acqua, Antonio</creator><creator>Dell’Acqua, Raffaele</creator><creator>Della Torre, Emanuel</creator><creator>Della Torre, Liviana</creator><creator>Di Terlizzi, Gaetano</creator><creator>Dumea, Iulia</creator><creator>Farolfi, Federica</creator><creator>Ferrante, Marica</creator><creator>Frangi, Claudia</creator><creator>Fumagalli, Luca</creator><creator>Gallina, Gabriele</creator><creator>Germinario, Bruno</creator><creator>Gianotti, Nicola</creator><creator>Guffanti, Monica</creator><creator>Hasson, Hamid</creator><creator>Lalla, Francesca</creator><creator>Lanzillotta, Marco</creator><creator>Li Voti, Raffaele</creator><creator>Messina, Emanuela</creator><creator>Molinari, Chiara</creator><creator>Moizo, Elena</creator><creator>Montagna, Marco</creator><creator>Morsica, Giulia</creator><creator>Nozza, Silvia</creator><creator>Pascali, Maria</creator><creator>Patrizi, Alessandro</creator><creator>Pieri, Marina</creator><creator>Poloniato, Antonella</creator><creator>Prestifilippo, Dario</creator><creator>Ramirez, Giuseppe</creator><creator>Ranzenigo, Martina</creator><creator>Sapienza, Jacopo</creator><creator>Seghi, Federico</creator><creator>Tambussi, Giuseppe</creator><creator>Tassan Din, Chiara</creator><creator>Turi, Stefano</creator><creator>Uberti-Foppa, Caterina</creator><creator>Vinci, Concetta</creator><general>Elsevier Ltd</general><general>European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210301</creationdate><title>Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors</title><author>Ripa, Marco ; Galli, Laura ; Poli, Andrea ; Oltolini, Chiara ; Spagnuolo, Vincenzo ; Mastrangelo, Andrea ; Muccini, Camilla ; Monti, Giacomo ; De Luca, Giacomo ; Landoni, Giovanni ; Dagna, Lorenzo ; Clementi, Massimo ; Rovere Querini, Patrizia ; Ciceri, Fabio ; Tresoldi, Moreno ; Lazzarin, Adriano ; Zangrillo, Alberto ; Scarpellini, Paolo ; Castagna, Antonella ; Andolina, Andrea ; Redaelli, Martina Baiardo ; Bigai, Giorgia ; Bigoloni, Alba ; Borio, Giorgia ; Bossolasco, Simona ; Bruzzesi, Elena ; Calabrò, Maria Grazia ; Calvisi, Stefania ; Campochiaro, Corrado ; Canetti, Diana ; Canti, Valentina ; Castellani, Jacopo ; Castiglioni, Barbara ; Cavalli, Giulio ; Cavallo, Ludovica ; Cernuschi, Massimo ; Chiurlo, Matteo ; Cilla, Marta ; Cinel, Elena ; Cinque, Paola ; Conte, Caterina ; Da Prat, Valentina ; Danise, Anna ; De Lorenzo, Rebecca ; Dell’Acqua, Antonio ; Dell’Acqua, Raffaele ; Della Torre, Emanuel ; Della Torre, Liviana ; Di Terlizzi, Gaetano ; Dumea, Iulia ; Farolfi, Federica ; Ferrante, Marica ; Frangi, Claudia ; Fumagalli, Luca ; Gallina, Gabriele ; Germinario, Bruno ; Gianotti, Nicola ; Guffanti, Monica ; Hasson, Hamid ; Lalla, Francesca ; Lanzillotta, Marco ; Li Voti, Raffaele ; Messina, Emanuela ; Molinari, Chiara ; Moizo, Elena ; Montagna, Marco ; Morsica, Giulia ; Nozza, Silvia ; Pascali, Maria ; Patrizi, Alessandro ; Pieri, Marina ; Poloniato, Antonella ; Prestifilippo, Dario ; Ramirez, Giuseppe ; Ranzenigo, Martina ; Sapienza, Jacopo ; Seghi, Federico ; Tambussi, Giuseppe ; Tassan Din, Chiara ; Turi, Stefano ; Uberti-Foppa, Caterina ; Vinci, Concetta</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-91a3e01249dfa4edbb43261e56ce6138f2c943ddd75d500be65cc6ef2a5bd3d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Bacterial infections</topic><topic>Bloodstream infections</topic><topic>Cohort Studies</topic><topic>Coinfection - epidemiology</topic><topic>Coinfection - microbiology</topic><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>Female</topic><topic>Fungal infections</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Incidence</topic><topic>Italy - epidemiology</topic><topic>Lower respiratory tract infections</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Respiratory Tract Infections - epidemiology</topic><topic>Respiratory Tract Infections - microbiology</topic><topic>Risk Factors</topic><topic>SARS-CoV-2</topic><topic>Secondary infections</topic><topic>Sepsis - epidemiology</topic><topic>Sepsis - etiology</topic><topic>Sepsis - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ripa, Marco</creatorcontrib><creatorcontrib>Galli, Laura</creatorcontrib><creatorcontrib>Poli, Andrea</creatorcontrib><creatorcontrib>Oltolini, Chiara</creatorcontrib><creatorcontrib>Spagnuolo, Vincenzo</creatorcontrib><creatorcontrib>Mastrangelo, Andrea</creatorcontrib><creatorcontrib>Muccini, Camilla</creatorcontrib><creatorcontrib>Monti, Giacomo</creatorcontrib><creatorcontrib>De Luca, Giacomo</creatorcontrib><creatorcontrib>Landoni, Giovanni</creatorcontrib><creatorcontrib>Dagna, Lorenzo</creatorcontrib><creatorcontrib>Clementi, Massimo</creatorcontrib><creatorcontrib>Rovere Querini, Patrizia</creatorcontrib><creatorcontrib>Ciceri, Fabio</creatorcontrib><creatorcontrib>Tresoldi, Moreno</creatorcontrib><creatorcontrib>Lazzarin, Adriano</creatorcontrib><creatorcontrib>Zangrillo, Alberto</creatorcontrib><creatorcontrib>Scarpellini, Paolo</creatorcontrib><creatorcontrib>Castagna, Antonella</creatorcontrib><creatorcontrib>Andolina, Andrea</creatorcontrib><creatorcontrib>Redaelli, Martina Baiardo</creatorcontrib><creatorcontrib>Bigai, Giorgia</creatorcontrib><creatorcontrib>Bigoloni, Alba</creatorcontrib><creatorcontrib>Borio, Giorgia</creatorcontrib><creatorcontrib>Bossolasco, Simona</creatorcontrib><creatorcontrib>Bruzzesi, Elena</creatorcontrib><creatorcontrib>Calabrò, Maria Grazia</creatorcontrib><creatorcontrib>Calvisi, Stefania</creatorcontrib><creatorcontrib>Campochiaro, Corrado</creatorcontrib><creatorcontrib>Canetti, Diana</creatorcontrib><creatorcontrib>Canti, Valentina</creatorcontrib><creatorcontrib>Castellani, Jacopo</creatorcontrib><creatorcontrib>Castiglioni, Barbara</creatorcontrib><creatorcontrib>Cavalli, Giulio</creatorcontrib><creatorcontrib>Cavallo, Ludovica</creatorcontrib><creatorcontrib>Cernuschi, Massimo</creatorcontrib><creatorcontrib>Chiurlo, Matteo</creatorcontrib><creatorcontrib>Cilla, Marta</creatorcontrib><creatorcontrib>Cinel, Elena</creatorcontrib><creatorcontrib>Cinque, Paola</creatorcontrib><creatorcontrib>Conte, Caterina</creatorcontrib><creatorcontrib>Da Prat, Valentina</creatorcontrib><creatorcontrib>Danise, Anna</creatorcontrib><creatorcontrib>De Lorenzo, Rebecca</creatorcontrib><creatorcontrib>Dell’Acqua, Antonio</creatorcontrib><creatorcontrib>Dell’Acqua, Raffaele</creatorcontrib><creatorcontrib>Della Torre, Emanuel</creatorcontrib><creatorcontrib>Della Torre, Liviana</creatorcontrib><creatorcontrib>Di Terlizzi, Gaetano</creatorcontrib><creatorcontrib>Dumea, Iulia</creatorcontrib><creatorcontrib>Farolfi, Federica</creatorcontrib><creatorcontrib>Ferrante, Marica</creatorcontrib><creatorcontrib>Frangi, Claudia</creatorcontrib><creatorcontrib>Fumagalli, Luca</creatorcontrib><creatorcontrib>Gallina, Gabriele</creatorcontrib><creatorcontrib>Germinario, Bruno</creatorcontrib><creatorcontrib>Gianotti, Nicola</creatorcontrib><creatorcontrib>Guffanti, Monica</creatorcontrib><creatorcontrib>Hasson, Hamid</creatorcontrib><creatorcontrib>Lalla, Francesca</creatorcontrib><creatorcontrib>Lanzillotta, Marco</creatorcontrib><creatorcontrib>Li Voti, Raffaele</creatorcontrib><creatorcontrib>Messina, Emanuela</creatorcontrib><creatorcontrib>Molinari, Chiara</creatorcontrib><creatorcontrib>Moizo, Elena</creatorcontrib><creatorcontrib>Montagna, Marco</creatorcontrib><creatorcontrib>Morsica, Giulia</creatorcontrib><creatorcontrib>Nozza, Silvia</creatorcontrib><creatorcontrib>Pascali, Maria</creatorcontrib><creatorcontrib>Patrizi, Alessandro</creatorcontrib><creatorcontrib>Pieri, Marina</creatorcontrib><creatorcontrib>Poloniato, Antonella</creatorcontrib><creatorcontrib>Prestifilippo, Dario</creatorcontrib><creatorcontrib>Ramirez, Giuseppe</creatorcontrib><creatorcontrib>Ranzenigo, Martina</creatorcontrib><creatorcontrib>Sapienza, Jacopo</creatorcontrib><creatorcontrib>Seghi, Federico</creatorcontrib><creatorcontrib>Tambussi, Giuseppe</creatorcontrib><creatorcontrib>Tassan Din, Chiara</creatorcontrib><creatorcontrib>Turi, Stefano</creatorcontrib><creatorcontrib>Uberti-Foppa, Caterina</creatorcontrib><creatorcontrib>Vinci, Concetta</creatorcontrib><creatorcontrib>COVID-BioB study group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical microbiology and infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ripa, Marco</au><au>Galli, Laura</au><au>Poli, Andrea</au><au>Oltolini, Chiara</au><au>Spagnuolo, Vincenzo</au><au>Mastrangelo, Andrea</au><au>Muccini, Camilla</au><au>Monti, Giacomo</au><au>De Luca, Giacomo</au><au>Landoni, Giovanni</au><au>Dagna, Lorenzo</au><au>Clementi, Massimo</au><au>Rovere Querini, Patrizia</au><au>Ciceri, Fabio</au><au>Tresoldi, Moreno</au><au>Lazzarin, Adriano</au><au>Zangrillo, Alberto</au><au>Scarpellini, Paolo</au><au>Castagna, Antonella</au><au>Andolina, Andrea</au><au>Redaelli, Martina Baiardo</au><au>Bigai, Giorgia</au><au>Bigoloni, Alba</au><au>Borio, Giorgia</au><au>Bossolasco, Simona</au><au>Bruzzesi, Elena</au><au>Calabrò, Maria Grazia</au><au>Calvisi, Stefania</au><au>Campochiaro, Corrado</au><au>Canetti, Diana</au><au>Canti, Valentina</au><au>Castellani, Jacopo</au><au>Castiglioni, Barbara</au><au>Cavalli, Giulio</au><au>Cavallo, Ludovica</au><au>Cernuschi, Massimo</au><au>Chiurlo, Matteo</au><au>Cilla, Marta</au><au>Cinel, Elena</au><au>Cinque, Paola</au><au>Conte, Caterina</au><au>Da Prat, Valentina</au><au>Danise, Anna</au><au>De Lorenzo, Rebecca</au><au>Dell’Acqua, Antonio</au><au>Dell’Acqua, Raffaele</au><au>Della Torre, Emanuel</au><au>Della Torre, Liviana</au><au>Di Terlizzi, Gaetano</au><au>Dumea, Iulia</au><au>Farolfi, Federica</au><au>Ferrante, Marica</au><au>Frangi, Claudia</au><au>Fumagalli, Luca</au><au>Gallina, Gabriele</au><au>Germinario, Bruno</au><au>Gianotti, Nicola</au><au>Guffanti, Monica</au><au>Hasson, Hamid</au><au>Lalla, Francesca</au><au>Lanzillotta, Marco</au><au>Li Voti, Raffaele</au><au>Messina, Emanuela</au><au>Molinari, Chiara</au><au>Moizo, Elena</au><au>Montagna, Marco</au><au>Morsica, Giulia</au><au>Nozza, Silvia</au><au>Pascali, Maria</au><au>Patrizi, Alessandro</au><au>Pieri, Marina</au><au>Poloniato, Antonella</au><au>Prestifilippo, Dario</au><au>Ramirez, Giuseppe</au><au>Ranzenigo, Martina</au><au>Sapienza, Jacopo</au><au>Seghi, Federico</au><au>Tambussi, Giuseppe</au><au>Tassan Din, Chiara</au><au>Turi, Stefano</au><au>Uberti-Foppa, Caterina</au><au>Vinci, Concetta</au><aucorp>COVID-BioB study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors</atitle><jtitle>Clinical microbiology and infection</jtitle><addtitle>Clin Microbiol Infect</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>27</volume><issue>3</issue><spage>451</spage><epage>457</epage><pages>451-457</pages><issn>1198-743X</issn><eissn>1469-0691</eissn><abstract>The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19).
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.
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).
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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>33223114</pmid><doi>10.1016/j.cmi.2020.10.021</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1198-743X |
| ispartof | Clinical microbiology and infection, 2021-03, Vol.27 (3), p.451-457 |
| issn | 1198-743X 1469-0691 |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Bacterial infections Bloodstream infections Cohort Studies Coinfection - epidemiology Coinfection - microbiology COVID-19 COVID-19 - epidemiology Female Fungal infections Hospitalization - statistics & numerical data Humans Incidence Italy - epidemiology Lower respiratory tract infections Male Middle Aged Original Respiratory Tract Infections - epidemiology Respiratory Tract Infections - microbiology Risk Factors SARS-CoV-2 Secondary infections Sepsis - epidemiology Sepsis - etiology Sepsis - microbiology |
| title | Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors |
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