Bacterial and fungal superinfections in critically ill patients with COVID-19
- PDF / 2,012,500 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 52 Downloads / 174 Views
UNDERSTANDING THE DISEASE
Bacterial and fungal superinfections in critically ill patients with COVID‑19 Matteo Bassetti1,2* , Marin H. Kollef3 and Jean‑Francois Timsit4,5 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Are critically ill patients with coronavirus disease 2019 (COVID-19) at high risk of bacterial and fungal superinfections developing on the top of the viral infection in the lung or in other body sites? And from which organisms? Answering these apparently simple questions could be far more difficult than expected, for at least three important reasons. The first one is that the timing of development of superinfection (early or late) with respect to the intensive care unit (ICU) admission may have relevant clinical implications. Indeed, borrowing from experiences in other ICU populations it cannot be excluded a priori that early and late superinfections may be profoundly different in terms of risk [1, 2]. However, early and late superinfections have been frequently lumped together in the currently available literature on COVID-19 patients, making it difficult to firmly grasp their separate risks [3, 4]. The second reason is that the high case fatality of the viral disease per se may be an important competing risk for the development of late superinfection, which may lead to an unintended underestimation of the risk of superinfection at the bedside of alive patients. The third reason specifically involves invasive aspergillosis, for which the current absence of a standardized definition for non-proven disease in non-neutropenic critically ill patients may preclude a reliable risk assessment also in COVID-19 patients [5]. In the next few paragraphs, we briefly discuss each of these three intertwined, important issues.
*Correspondence: [email protected] 1 Clinica Malattie Infettive, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi 10, 16132 Genoa, Italy Full author information is available at the end of the article
Early and late superinfections The prevalence of laboratory-confirmed bacterial superinfection in critically ill COVID-19 patients in ICU could be around 14% (95% confidence interval 5–26%) according to a recent meta-analysis [3]. However, in most included studies there was no distinction between early and late infections. Although on the surface this may appear mere semantics, in reality such a distinction has important implications for antimicrobial prescribing in real life. Indeed, should it be proven that most superinfections in critically ill COVID-19 patients develop late and not early during the ICU stay (or during exposure to the hospital environment), the widespread attitude toward universally prescribing empirical antibacterials in critically ill COVID-19 patients since ICU/hospital admission could no longer be supported [4]. This is in line with a recent observational cohort of 78 critically ill COVID-19 patients, in whom the cumulative risk of developing a bloodstream infection (BSI) after at least 48 h from ICU admission was estimated to be of almost 2
Data Loading...
