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Secondary Infections in Critically Ill Patients with COVID-19

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Annual Update in Intensive Care and Emergency Medicine 2021

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Critically ill patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19), are at increased risk of developing secondary infections during the intensive care unit (ICU) stay, mainly due to the prolonged length of stay, the impairment of the immune system and the use of drugs interfering with immune system function (i.e., corticosteroids, cytokine inhibitors). Data describing the epidemiology of secondary infections in patients with COVID-19 and their impact on outcome are scarce. The most common bacterial complications are ventilator-associated pneumonia (VAP), mainly due to Gram-negative pathogens (Pseudomonas aeruginosa, Enterobacter spp., Escherichia coli), detected in up to 58% of patients, and bloodstream infections (BSI), frequently associated with coagulase-negative staphylococci and diagnosed in 25–50% of patients. Invasive pulmonary aspergillosis, mainly due to Aspergillus flavus, is also frequent, reaching an incidence of 20–35%. Diagnosis of secondary infections is based on clinical signs and symptoms, radiological findings and microbiological cultures from suspected infection sites (i.e., respiratory tract specimens, blood cultures). Although early guidelines for the management of COVID-19 in ICU patients suggested empirical antibacterial treatment in all mechanically ventilated patients, recent data show that antibiotics should be introduced only when a clear co-infection or secondary infection is demonstrated. The choice of antimicrobial treatment should be guided by the specific microbiology pattern of the hospital and by the results of the microbiological cultures. Due to the impact of secondary infections on patient prognosis in COVID-19, early diagnosis and prompt introduction of appropriate antimicrobial treatment are fundamental to improve patient outcome.

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Authors and Affiliations

  1. Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    G. Grasselli, E. Cattaneo & G. Florio

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy

    G. Grasselli, E. Cattaneo & G. Florio

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  1. G. Grasselli
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  2. E. Cattaneo
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  3. G. Florio
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Correspondence to G. Grasselli .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Grasselli, G., Cattaneo, E., Florio, G. (2021). Secondary Infections in Critically Ill Patients with COVID-19. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2021. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-73231-8_5

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  • DOI: https://doi.org/10.1007/978-3-030-73231-8_5

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