Table 3.
Summary of Included Studies Involving Patients With COVID-19 and Hospital-Acquired (HA) Secondary Bacterial Infections
| Study | Study Type/Date | Total COVID-19 Patients, No. | Secondary Infection Type a /Acquisition Setting | Time of Infection Diagnosis a | Rate of Secondary Bacterial Infection b | Mortality Outcomes in COVID-19 Patients With Secondary Bacterial Infection c | Other Outcomes Reported in COVID-19 Patients With Secondary Bacterial Infection d |
|---|---|---|---|---|---|---|---|
| Observational studies, South America | |||||||
| Martinez-Guerra et al, 2021 12 | Prospective cohort, 1 hospital, Mexico (March–June 2020) | 794 | HA bacterial infection/inpatient | Median hospital stay at diagnosis, 9 d | Overall infection, 74 (11.3%) of 656; VAP/HAP, 56 (50.9%) of 110 episodes; BSI, 6 (29.1%) of 110 episodes |
Mortality rate, 30 (40.5%) of 74 vs 33% w/o infection (P < .05) | Hospital LOS |
| Silva et al, 2021 11 | Retrospective cohort, 1 hospital, Brazil (May–November 2020) |
212 | HA bacterial and fungal infection/inpatient | NR | Bacterial, 34 (16%) of 212 | Increased risk of death with bacterial infection | NR |
| Observational studies, United States | |||||||
| Nori et al, 2020 28 | Retrospective cohort, 1 hospital, USA (March–April 2020) |
4,267 | HA bacterial or fungal infection, inpatient | Time to culture positivity, 6–7 d | Bacterial/fungal, 152 (3.6%) of 4,267 | Mortality rate, 68 (57%) of 152 | Hospital LOS, ICU admission |
| Gomez-Simmonds et al, 2021 45 | Retrospective cohort, 1 hospital, USA (March–April 2020) |
3,152; 13 with CPE infection | HA CPE infection/inpatient | NR | CPE, 13 (0.4%) of 3,152; respiratory, 11 (0.3%) of 3,152; bacteremia, 7 (0.2%) of 3,152 | Mortality rate, 5 (38.5%) of 13 | ICU admission rate and MV rate |
| Adelman et al, 2021 37 | Retrospective cohort, 4 hospitals, USA (February–May 2020) |
774 | HA bacterial pneumonia and BSIs/inpatient | NR | BSI, 36 (4.7%) of 774; respiratory, 65 (27.3%) of 238 intubated patients; VAP, 2% |
Mortality rate in patients with BSI, 50%; m ortality rate in intubated patients, 41.5% |
NR |
| Chong et al, 2021 40 | Retrospective cohort, 1 hospital, USA (March–June 2020) |
244 | HA pulmonary bacterial infection/inpatient | ≥48 h after admission | Pulmonary, 13 (5%) of 244 | No difference in mortality vs w/o infection | hospital LOS, ICU admission rate, MV rate |
| Obata et al, 2020 48 | Retrospective cohort, 1 hospital, USA (March–May 2020) |
226: 57 received steroid; 169 w/o steroids (n=169) | HA bacterial infection/inpatient | NR | Bacterial infection in steroid group, 14 (24.6%) of 57 vs 19 (11.2%) of 169 w/o steroids | NR d | NR d |
| Kimmig et al, 2020 47 | Retrospective cohort, 1 ICU, USA (March–April 2020) | 111: 48 treated with tocilizumab; 63 w/o tocilizumab | HA bacterial infection/inpatient | NR | Patients treated with tocilizumab: bacterial, 24 (50%) of 48, VAP/HAP, 18 (37.5%) of 48. Patients w/o tocilizumab: bacterial, 18 (28.6%) of 63, VAP/HAP, 11 (17.5%) of 63 | NR d | NR d |
| Observational studies, Europe | |||||||
| Ripa et al, 2020 19 | Cohort study, 1 hospital, Italy (February–April 2020) | 731 | HA bacterial infection/inpatient | ≥48 h after admission | Overall infection, 68 (9.3%) of 731g; possible LRTI 22 (3.0%) of 731; BSI, 58 (7.9%) of 731 | Mortality rate, 30 (44.1%) of 68 vs 24.7% w/o HA infection (P < .001) |
ICU admission rate |
| Posteraro et al, 2021 35 | Retrospective cohort, 1 hospital, Italy (March–May 2020) |
293; 46 with BSI | HA BSI/inpatient | >48 h after admission or after discharge from previous hospital | BSI, 46 (15.7%) of 293g | Mortality rate, 20 (43.5%) of 46 vs 52 (24.2%) of 215 w/o positive blood cultures (P = .008) | NR |
| Guisado-Gil et al, 2020 50 | Retrospective cohort, 1 hospital, Spain (March–May 2020) |
282 | HA candidemia and MDR BSIs/inpatient | HA, >48 h after admission | Incidence candidemia and bacterial BSI per 1,000 OBD: Q1 2020, 0.37 cases; Q2 2020, 0.24 cases | Mortality rate, 17.6% at day 14 and 26.5% at day 30 in patients with MDR BSIs | NR |
| Magnasco et al, 2020 51 | Retrospective cohort, 2 ICUs, Italy (February– May 2020) | 118 | HA drug-resistant infectione/inpatient | HA, 10–30 d after ICU admission | Drug resistant, 14 (11.9%) of 118; CRPA, 12 (10.2%) of 118; CR-Kp, 2 (1.6%) of 118f | Patients with CRPA: crude mortality rate, 5 (41.7%) of 12. Patients with CR-Kp: observed mortality rate, 1 (50%) of 2 |
ICU LOS |
| Pink et al, 2021 20 | Retrospective cohort, 1 hospital, Germany (March–October 2020) | 99 | HA bacterial infection/inpatient | NR | Bacterial, 32% | NR d | NR d |
| Bogossian et al, 2020 42 | Retrospective case control study, 1 ICU, Belgium (March–April 2020) | 72 | HA MDR bacterial infection/inpatient | NR | MDR bacterial, 24 (33%) of 72 | ICU mortality rate, 6 (25%) of 24; hospital mortality rate, 6 (25%) of 23 |
Hospital LOS, ICU LOS, MV rate, MV duration |
| García-Meniño et al, 2021 44 | Case series, 1 ICU, Spain (February 2020) |
62 | HA CP-Kp infection/inpatient | 4–15 d after ICU admission | CP-Kp, 7 (11.3%) of 62 | Mortality rate, 1 (14.3%) of 7 | MV rate |
| Buehler et al, 2021 30 | Prospective cohort study, 1 ICU, Switzerland (April–June 2020) | 45 | HA pulmonary infection/inpatient | Day 10 after ICU admission (mean) | Bacterial/fungal, 19 (42.2%) of 45 | NR | ICU LOS, MV duration |
| Montrucchio et al, 2020 65 | Cohort study, 1 ICU, Italy (March–May 2020) | 35 | HA CP-Kp infection/inpatient | 6–22 d after ICU admission | CP-Kp, 7 (20%) of 35 | 28-d mortality rate, 2 (28.6%) of 7 | ICU LOS, MV duration |
| Observational studies, Asia | |||||||
| Lee et al, 2021 38 | Retrospective cohort, 1 hospital Korea (February– July 2020) | 140 | HA infection/inpatient | 5.8 ± 6.7 d after admission | Overall secondary infection, 31 (22.1%) of 140; secondary bacterial infection, 30 (21.4%) of 140 | Mortality rate, 6.5% vs 0% w/o HA infection (P = .048) | MV rate |
| Yang et al, 2020 29 | Retrospective cohort, 1 ICU, China (December 2020–January 2021) | 52 | HA bacterial and fungal infection/inpatient | NR | Bacterial/fungal, 7 (13.5%) of 52 | NR d | NR d |
| Fu et al, 2020 43 | Retrospective cohort, 1 ICU, China (February–April 2020) | 36 | HA bacterial infection/inpatient | Average time from ICU admission, 11 d | Bacterial, 5 (13.9%) of 36 | Mortality rate, 1 (20%) of 5 | MV rate |
Note. BSI, bloodstream infections; CPE, carbapenemase-producing Enterobacterales; CR-Kp, carbapenem-resistant Klebsiella pneumoniae; CRPA, carbapenem-resistant Pseudomonas aeruginosa; ED, emergency department; EU, European Union; HA, hospital-acquired; HAP, hospital-acquired pneumonia; HFNT, high flow nasal therapy; ICU, intensive care unit; LOS, length of stay; MDR, multidrug resistant; MV, mechanical ventilation; NR, not reported; OBD, occupied bed d; OR, odds ratio; patients, patients; VAP, ventilator-associated pneumonia; w/o, without.
a
Based on published information, including clinical details, or on the time of infection diagnosis: ≥4 d of hospitalization = hospital-acquired infection, unless otherwise stated in the source.
b
Rates were reported per total number of patients with COVID-19.
c
Data for hospital/ICU LOS, ICU admission rates, MV rates, MV duration in patients with COVID-19 who secondary bacterial infections.
d
Outcomes were reported in total patient population.