Incidence, risk factors and outcomes of healthcare-associated bacterial infections in COVID-19 patients receiving respiratory support: a retrospective cohort study

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-09-05 DOI:10.1016/j.jiph.2025.102964

Matteo Augello , Roberto Castoldi , Alessandro Tavelli , Riccardo Nardo , Valentina Sala , Lorenzo Albertini , Lorenzo Brando Lundgren , Sara De Benedittis , Elisa Borghi , Ottavia Viganò , Giulia Marchetti

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引用次数: 0

Abstract

Objective

The aim of the present study was to assess the incidence, risk factors and outcomes of bacterial healthcare-associated infections (HAIs) in COVID-19 patients receiving respiratory support.

Methods

This retrospective study included COVID-19 hospitalised patients requiring either invasive or non-invasive respiratory support at the ASST Santi Paolo e Carlo in Milan (Italy) from September 2020 to December 2021. Data on demographics, clinical/laboratory findings, and outcomes were extracted from electronic health records. The cumulative incidence rate of a first HAI episode was evaluated by cumulative incidence function. Risk factors for bacterial HAIs and their association with in-hospital mortality were analysed using Fine-Gray proportional hazard models.

Results

Among 744 patients, 118 (15.9 %) developed at least one bacterial HAI during respiratory support, mostly caused by Gram-negative bacteria. The cumulative incidence of HAIs was 15.7 % by 30 days, and significantly higher in intensive care unit (ICU) settings compared to medical/surgical units (MSUs). Independent risk factors for HAIs were male sex [adjusted subhazard ratio (aSHR) 2.29, 95 % CI 1.39–3.78], ICU stay (aSHR 7.61, 95 % CI 3.32–17.43), and therapy with biological drugs (aSHR 2.11, 95 % CI 1.05–4.23). HAIs were associated with an increased risk of in-hospital mortality (aSHR 2.06, 95 % CI 1.44–2.96), with both pneumonias and bloodstream infections contributing significantly to mortality.

Conclusions

Bacterial HAIs are common in COVID-19 patients on respiratory support, especially in ICU settings, and are associated with increased mortality.

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接受呼吸支持的COVID-19患者中卫生保健相关细菌感染的发生率、危险因素和结局：一项回顾性队列研究

目的：本研究旨在评估接受呼吸支持的COVID-19患者细菌性卫生保健相关感染（HAIs）的发生率、危险因素和结局。方法：本回顾性研究纳入了2020年9月至2021年12月在意大利米兰圣保罗卡洛助理医院接受有创或无创呼吸支持治疗的COVID-19住院患者。从电子健康记录中提取了人口统计、临床/实验室结果和结果数据。采用累积发生率函数评价首次HAI的累积发病率。使用Fine-Gray比例风险模型分析细菌性HAIs的危险因素及其与院内死亡率的关系。结果：744例患者中，118例（15.9 %）在呼吸支持期间发生至少一种细菌性HAI，主要由革兰氏阴性菌引起。30天内HAIs的累计发生率为15.7 %，重症监护病房（ICU）的发生率明显高于内科/外科病房（msu）。HAIs的独立危险因素为男性[调整亚危险比（aSHR） 2.29, 95 % CI 1.39 ~ 3.78]、ICU住院时间（aSHR 7.61, 95 % CI 3.32 ~ 17.43）和生物药物治疗（aSHR 2.11, 95 % CI 1.05 ~ 4.23）。HAIs与院内死亡风险增加相关（aSHR 2.06, 95 % CI 1.44-2.96），肺炎和血液感染对死亡率都有显著影响。结论：细菌性HAIs在接受呼吸支持的COVID-19患者中很常见，特别是在ICU环境中，并且与死亡率增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.