Bacterial Pulmonary Co-Infections on ICU Admission: Comparison in Patients with

SARS-CoV-2 and Influenza Acute Respiratory Failure: A Multicentre Cohort Study.

 

Delhommeau G(1), Buetti N(2)(3), Neuville M(4), Siami S(5), Cohen Y(6), Laurent

V(7), Mourvillier B(8), Reignier J(9), Goldgran-Toledano D(10), Schwebel C(11),

Ruckly S(2), de Montmollin E(2)(12), Souweine B(13), Timsit JF(2)(12), Dupuis

C(13)(14).

 

KEY FINDINGS :

SARS-CoV-2 pneumonia was associated with an increased risk of

mortality compared with Influenza pneumonia. Bacterial pulmonary co-infections

on admission were not associated with patient survival rates nor with an

increased risk of VAP.

 

BACKGROUND: Few data are available on the impact of bacterial pulmonary

co-infection (RespCoBact) during COVID-19 (CovRespCoBact). The aim of this study

was to compare the prognosis of patients admitted to an ICU for influenza

pneumonia and for SARS-CoV-2 pneumonia with and without RespCoBact.

METHODS: This was a multicentre (n = 11) observational study using the

Outcomerea© database. Since 2008, all patients admitted with influenza pneumonia

or SARS-CoV-2 pneumonia and discharged before 30 June 2021 were included. Risk

factors for day-60 death and for ventilator-associated-pneumonia (VAP) in

patients with influenza pneumonia or SARS-CoV-2 pneumonia with or without

RespCoBact were determined.

RESULTS: Of the 1349 patients included, 157 were admitted for influenza and 1192

for SARS-CoV-2. Compared with the influenza patients, those with SARS-CoV-2 had

lower severity scores, were more often under high-flow nasal cannula, were less

often under invasive mechanical ventilation, and had less RespCoBact (8.2% for

SARS-CoV-2 versus 24.8% for influenza). Day-60 death was significantly higher in

patients with SARS-CoV-2 pneumonia with no increased risk of mortality with

RespCoBact. Patients with influenza pneumonia and those with SARS-CoV-2

pneumonia had no increased risk of VAP with RespCoBact.

CONCLUSIONS: SARS-CoV-2 pneumonia was associated with an increased risk of

mortality compared with Influenza pneumonia. Bacterial pulmonary co-infections

on admission were not associated with patient survival rates nor with an

increased risk of VAP.

 

DOI: 10.3390/biomedicines10102646

PMCID: PMC9599916

PMID: 36289906

 

Conflict of interest statement: J.-F.T. reported scientific advisory board

membership for Merck, Shionogi, Paratek, Gilead, Pfizer, Becton-Dickinson, and

Aspen not related to the submitted work. J.-F.T. reported lectures given during

Merck, Shionogi, Gilead, Pfizer, and Bection-Dickinson symposia not related to

the submitted work. The other authors have no conflicts of interest to declare.

 

 

Different epidemiology of bloodstream infections in COVID-19 compared to

non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II

study.

 

Buetti N(1)(2), Tabah A(3)(4)(5), Loiodice A(6), Ruckly S(6), Aslan AT(7),

Montrucchio G(8)(9), Cortegiani A(10)(11), Saltoglu N(12), Kayaaslan B(13),

Aksoy F(14), Murat A(15), Akdoğan Ö(16), Saracoglu KT(17), Erdogan C(18), Leone

M(19), Ferrer R(20), Paiva JA(21)(22), Hayashi Y(23), Ramanan M(24)(25)(26),

Conway Morris A(27)(28)(29), Barbier F(30)(31), Timsit JF(32)(33); Eurobact 2

study group.

 

KEY FINDINGS:

HA-BSI is frequent in Cocid-19 ICU patients. Enterococcal HABSI predominated in COVID-19 patients.

COVID-19 patients with HABSI had elevated risk of mortality

 

BACKGROUND: The study aimed to describe the epidemiology and outcomes of

hospital-acquired bloodstream infections (HABSIs) between COVID-19 and

non-COVID-19 critically ill patients.

METHODS: We used data from the Eurobact II study, a prospective observational

multicontinental cohort study on HABSI treated in ICU. For the current analysis,

we selected centers that included both COVID-19 and non-COVID-19 critically ill

patients. We performed descriptive statistics between COVID-19 and non-COVID-19

in terms of patients' characteristics, source of infection and microorganism

distribution. We studied the association between COVID-19 status and mortality

using multivariable fragility Cox models.

RESULTS: A total of 53 centers from 19 countries over the 5 continents were

eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538

[64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%)

COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between

hospital admission and HABSI was similar between both groups. Respiratory

sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%,

p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more

often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%)

HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio

(HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49-2.45).

CONCLUSIONS: We showed that the epidemiology of HABSI differed between COVID-19

and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients.

COVID-19 patients with HABSI had elevated risk of mortality. Trial registration

ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

 

© 2022. The Author(s).

 

DOI: 10.1186/s13054-022-04166-y

PMCID: PMC9578203

PMID: 36258239 [Indexed for MEDLINE]

 

Conflict of interest statement: The authors have disclosed that they do not have

conflict of interest. Dr. Buetti received a grant from the Swiss National

Science Foundation (Grant Number: P4P4PM_194449). Prof. Timsit received fees for

lectures to 3M, MSD, Pfizer, and BioMérieux; he received research grants from

Astellas, 3M, MSD, and Pfizer; and he participated to advisory boards of 3M,

MSD, Bayer Pharma, Nabriva, and Pfizer. Dr. Barbier received consulting and

lecture fees from MSD and BioMérieux. Prof. Cortegiani received fees for

lectures from Gilead, MSD, Pfizer; and he participated to advisory boards of

MSD, Gilead, Pfizer. Dr. Montrucchio received fees for lectures from Gilead,

Pfizer, Thermofisher; and she participated to advisory boards of Gilead. Dr.

Conway Morris sits on the scientific advisory board of Cambridge Infection

Diagnostics. Prof. Akova received grants from Pfizer and Gilead, had lecture

fees paid to the institution by Pfizer and Sanofi. Dr. Ramanan acknowledges

support from the Metro North Hospital and Health Services Clinician-Researcher

Fellowship. Dr. Conway Morris sits on the scientific advisory board of Cambridge

Infection Diagnostics. Dr. Conway Morris is supported by a Clinician Scientist

Fellowship from the Medical Research Council (MR/V006118/1). Prof. José-Artur

Paiva received fees for consulting, advisory boards or lectures from MSD,

Pfizer, Astra-Zeneca, Gilead, Jansen, Cepheid, AOP Orphan Pharmaceuticals.

 

 

Mid-Regional Pro-Adrenomedullin as a Prognostic Factor for Severe COVID-19 ARDS.

 

de Montmollin E(1)(2), Peoc'h K(3)(4), Marzouk M(2), Ruckly S(1), Wicky PH(2),

Patrier J(2), Jaquet P(2), Sonneville R(1)(2), Bouadma L(1)(2), Timsit JF(1)(2).

 

KEY -FINDING

Based on the Outcomerea biobank we found the MR Pro ADM is associated with prognosis in severe sars-Cov2 ARF. It may reflect endothelial dysfunction as a possible factor contributing to poor prognosis in this disease.

 

Mid-regional proadrenomedullin (MR-proADM) protects against endothelial

permeability and has been associated with prognosis in bacterial sepsis. As

endothelial dysfunction is central in the pathophysiology of severe SARS-CoV-2

infection, we sought to evaluate MR-proADM both as a prognostic biomarker and as

a marker of bacterial superinfection. Consecutive patients admitted to the ICU

for severe SARS-CoV-2 pneumonia were prospectively included and serum was

bio-banked on days 1, 3, and 7. MR-proADM levels were measured blindly from

clinical outcomes in batches at the end of follow-up. Among the 135 patients

included between April 2020 and May 2021, 46 (34.1%) had died at day 60.

MR-proADM levels on days 1, 3, and 7 were significantly higher in day-60

non-survivors. The area under the curve (AUC) of the receiver operating

characteristic (ROC) curve (0.744, p < 0.001) of day-1 MR-proADM compared

favorably with the AUC ROC curve of day-1 procalcitonin (0.691, p < 0.001).

Serial MR-proADM measurements on days 3 and 7 may add prognostic information.

After adjusting for CRP, LDH, and lymphocyte values, day-1 MR-proADM remained

significantly associated with day-60 mortality. MR-proADM concentrations were

significantly higher in patients with respiratory superinfections (on days 3 and

7) and bloodstream infections (on days 1, 3, and 7) than in patients without

infection. Our results suggest that MR-proADM is a good predictor of outcome in

severe SARS-CoV-2 infection and could be a useful tool to assess bacterial

superinfection in COVID-19 patients.

 

DOI: 10.3390/antibiotics11091166

PMCID: PMC9495198

PMID: 36139946

 

Conflict of interest statement: The authors received a research grant from

Thermo Fisher to perform the study. Outside of the study, J.-F.T. declares a

participation to the boards of Merck, Pfizer, BD, Gilead and Paratek, and

lecture fees for Pfizer, Shionogi, BD and Merck.