Epidemiological and Clinical Characterization of Superinfections in Critically Ill Coronavirus Disease 2019 Patients

Design: Retrospective analysis of prospectively collected observational data.

Setting: University-affiliated adult ICU.

Patients: Ninety-two coronavirus disease 2019 patients admitted to the ICU from February 21, 2020, to May 6, 2020.

Interventions: None.

Measurements And Main Results: The prevalence of superinfection at ICU admission was 21.7%, and 53 patients (57.6%) had at least one superinfection during ICU stay, with a total of 75 (82%) ventilator-associated pneumonia and 57 (62%) systemic infections. The most common pathogens responsible for ventilator-associated pneumonia were ( = 26, 34.7%) and ( = 14, 18.7%). Bloodstream infection occurred in 16 cases, including methicillin-resistant ( = 8, 14.0%), species ( = 6, 10.5%), and species ( = 2, 3.5%). Fungal infections occurred in 41 cases, including 36 probable (30 by , six by ) and five proven invasive candidiasis (three , two ). Presence of bacterial infections (odds ratio, 10.53; 95% CI, 2.31-63.42; = 0.005), age (odds ratio, 1.17; 95% CI, 1.07-1.31; = 0.001), and the highest Sequential Organ Failure Assessment score (odds ratio, 1.27; 95% CI, 1.06-1.63; = 0.032) were independently associated with ICU or 28-day mortality.

Conclusions: Prevalence of superinfections in coronavirus disease 2019 patients requiring mechanical ventilation was high in this series, and bacterial superinfections were independently associated with ICU or 28-day mortality (whichever comes first).