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de Macedo V, Santos GS, Silva RN, Couto CNM, Bastos C, Viecelli E, Mateus MN, Graf ME, Gonçalves RB, Silva MA, Bernardini PDB, Grando RSP, Boaventura VP, Pereira HSR, Levin ASS. Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units. J Hosp Infect 2022; 126:109-115. [PMID: 35623469 PMCID: PMC9131443 DOI: 10.1016/j.jhin.2022.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022]
Abstract
Background Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU). Methods This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders. Results In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43–2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70–2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78–28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31–10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88–0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO2/FiO2 ratio. Conclusions No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.
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Affiliation(s)
- V de Macedo
- Hospital Infection Control and Epidemiology Center, Santa Casa de Curitiba, Curitiba, Paraná, Brazil; Positive University, Medicine School, Curitiba, Paraná, Brazil; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
| | - G S Santos
- Hospital Infection Control and Epidemiology Center, Rehabilitation Hospital, Curitiba, Paraná, Brazil
| | - R N Silva
- Infection Control Program, Hospital de Clínicas, Curitiba, Paraná, Brazil
| | - C N M Couto
- Pontifical Catholic University of Paraná, Medicine School, Curitiba, Paraná, Brazil
| | - C Bastos
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - E Viecelli
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - M N Mateus
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - M E Graf
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - R B Gonçalves
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - M A Silva
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - P D B Bernardini
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - R S P Grando
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - V P Boaventura
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - H S R Pereira
- Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil
| | - A S S Levin
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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