Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes
Background Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients. Methods A retrospective, single-center cohort of critical COVI...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Critical Care Medicine
2023-11-01
|
| Series: | Acute and Critical Care |
| Subjects: | |
| Online Access: | http://www.accjournal.org/upload/pdf/acc-2023-00773.pdf |
| _version_ | 1797307091664240640 |
|---|---|
| author | Ahlem Trifi Selim Sellaouti Asma Mehdi Lynda Messaoud Eya Seghir Badis Tlili Sami Abdellatif |
| author_facet | Ahlem Trifi Selim Sellaouti Asma Mehdi Lynda Messaoud Eya Seghir Badis Tlili Sami Abdellatif |
| author_sort | Ahlem Trifi |
| collection | DOAJ |
| description | Background Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients. Methods A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints. Results Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004). Conclusions During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor. |
| first_indexed | 2024-03-08T00:51:23Z |
| format | Article |
| id | doaj.art-cf40a09dd44f4a988072b7e24fd38b75 |
| institution | Directory Open Access Journal |
| issn | 2586-6052 2586-6060 |
| language | English |
| last_indexed | 2024-03-08T00:51:23Z |
| publishDate | 2023-11-01 |
| publisher | Korean Society of Critical Care Medicine |
| record_format | Article |
| series | Acute and Critical Care |
| spelling | doaj.art-cf40a09dd44f4a988072b7e24fd38b752024-02-15T04:08:23ZengKorean Society of Critical Care MedicineAcute and Critical Care2586-60522586-60602023-11-0138442543410.4266/acc.2023.007731492Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomesAhlem TrifiSelim SellaoutiAsma MehdiLynda MessaoudEya SeghirBadis TliliSami AbdellatifBackground Coronavirus disease 2019 (COVID-19) pandemic disrupted adherences to healthcare-associated infection (HAI) prevention protocols. Herein, we studied the characteristics of all HAIs occurring in critically ill COVID-19 patients. Methods A retrospective, single-center cohort of critical COVID-19 patients during 2021. Microbiological samples were collected if HAI was suspected. We analyzed all factors that could potentially induce HAI, using septic shock and mortality as endpoints. Results Sixty-four among 161 included patients (39.7%) presented a total of 117 HAIs with an incidence density of 69.2 per 1,000 hospitalization days. Compared to the prior COVID-19 period (2013–2019), the identification of HAI increased in 2021. HAIs were classified into ventilator-associated pneumonia (VAP; n=38), bloodstream infection (n=32), urinary tract infection (n=24), catheter-related infection (n=12), and fungal infection (n=11). All HAIs occurred significantly earlier in the post–COVID-19 period (VAP: 6 vs. 10 days, P=0.045, in 2017 and 2021). Acinetobacter baumannii (39.5%) and Klebsiella pneumoniae (27%) were the most commonly isolated pathogens that exhibited a multidrug-resistant (MDR) profile, observed in 89% and 64.5%, respectively. The HAI factors were laboratory abnormalities (odds ratio [OR], 6.4; 95% confidence interval [CI], 2.3–26.0), cumulative steroid dose (OR, 1.9; 95% CI, 1.3–4.0), and invasive procedures (OR, 20.7; 95% CI, 5.3–64.0). HAI was an independent factor of mortality (OR, 8.5; P=0.004). Conclusions During the COVID-19 era, the incidence of HAIs increased and MDR isolates remained frequent. A severe biological inflammatory syndrome, invasive devices, and elevated cumulative steroid dosages were related to HAIs. HAI was a significant death factor.http://www.accjournal.org/upload/pdf/acc-2023-00773.pdfcovid-19critical careepidemiologyhealthcare-associated infectionsprognosis |
| spellingShingle | Ahlem Trifi Selim Sellaouti Asma Mehdi Lynda Messaoud Eya Seghir Badis Tlili Sami Abdellatif Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes Acute and Critical Care covid-19 critical care epidemiology healthcare-associated infections prognosis |
| title | Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes |
| title_full | Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes |
| title_fullStr | Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes |
| title_full_unstemmed | Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes |
| title_short | Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes |
| title_sort | healthcare associated infections in critical covid 19 patients in tunis epidemiology risk factors and outcomes |
| topic | covid-19 critical care epidemiology healthcare-associated infections prognosis |
| url | http://www.accjournal.org/upload/pdf/acc-2023-00773.pdf |
| work_keys_str_mv | AT ahlemtrifi healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes AT selimsellaouti healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes AT asmamehdi healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes AT lyndamessaoud healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes AT eyaseghir healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes AT badistlili healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes AT samiabdellatif healthcareassociatedinfectionsincriticalcovid19patientsintunisepidemiologyriskfactorsandoutcomes |