Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study
The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19...
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MDPI AG
2024-02-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/13/2/192 |
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| author | Lenka Doubravská Miroslava Htoutou Sedláková Kateřina Fišerová Olga Klementová Radovan Turek Kateřina Langová Milan Kolář |
| author_facet | Lenka Doubravská Miroslava Htoutou Sedláková Kateřina Fišerová Olga Klementová Radovan Turek Kateřina Langová Milan Kolář |
| author_sort | Lenka Doubravská |
| collection | DOAJ |
| description | The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and <i>Staphylococcus aureus</i>. Notably, no strains of <i>Streptococcus pneumoniae</i> were detected, and only a single strain each of <i>Haemophilus influenzae</i> and <i>Moraxella catarrhalis</i> was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6). |
| first_indexed | 2024-03-07T22:44:54Z |
| format | Article |
| id | doaj.art-c1d2b54f432a4b04bc75b159c58562c3 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-07T22:44:54Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-c1d2b54f432a4b04bc75b159c58562c32024-02-23T15:05:14ZengMDPI AGAntibiotics2079-63822024-02-0113219210.3390/antibiotics13020192Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort StudyLenka Doubravská0Miroslava Htoutou Sedláková1Kateřina Fišerová2Olga Klementová3Radovan Turek4Kateřina Langová5Milan Kolář6Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech RepublicDepartment of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech RepublicDepartment of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech RepublicDepartment of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech RepublicDepartment of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech RepublicDepartment of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech RepublicDepartment of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech RepublicThe impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and <i>Staphylococcus aureus</i>. Notably, no strains of <i>Streptococcus pneumoniae</i> were detected, and only a single strain each of <i>Haemophilus influenzae</i> and <i>Moraxella catarrhalis</i> was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).https://www.mdpi.com/2079-6382/13/2/192severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)critical coronavirus disease 19 (COVID-19)adult respiratory distress syndrome (ARDS)bacterial pneumoniacommunity-acquired pneumonia (CAP)hospital-acquired pneumonia (HAP) |
| spellingShingle | Lenka Doubravská Miroslava Htoutou Sedláková Kateřina Fišerová Olga Klementová Radovan Turek Kateřina Langová Milan Kolář Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study Antibiotics severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) critical coronavirus disease 19 (COVID-19) adult respiratory distress syndrome (ARDS) bacterial pneumonia community-acquired pneumonia (CAP) hospital-acquired pneumonia (HAP) |
| title | Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study |
| title_full | Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study |
| title_fullStr | Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study |
| title_full_unstemmed | Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study |
| title_short | Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19—A Prospective Monocentric Cohort Study |
| title_sort | bacterial community and hospital acquired pneumonia in patients with critical covid 19 a prospective monocentric cohort study |
| topic | severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) critical coronavirus disease 19 (COVID-19) adult respiratory distress syndrome (ARDS) bacterial pneumonia community-acquired pneumonia (CAP) hospital-acquired pneumonia (HAP) |
| url | https://www.mdpi.com/2079-6382/13/2/192 |
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