Acute Crit Care.  2023 Nov;38(4):425-434. 10.4266/acc.2023.00773.

Healthcare-associated infections in critical COVID-19 patients in Tunis: epidemiology, risk factors, and outcomes

• Trifi A
• Sellaouti S
• Mehdi A
• Messaoud L
• Seghir E
• Tlili B
• Abdellatif S

• KMID: 2550898
• DOI: http://doi.org/10.4266/acc.2023.00773

Abstract

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.

Keyword

COVID-19; critical care; epidemiology; healthcare-associated infections; prognosis

Figure

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  Figure 1. Study diagram. ICU: intensive care unit; COVID-19: coronavirus disease 2019; HAI: healthcare-associated infection; VAP: ventilator-associated pneumonia; UTI: urinary tract infection; CRI: catheter-related infection.

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  Figure 2. Incidence density (A) and time to onset (B) of healthcare-associated infections (HAIs) before and during the coronavirus disease 2019 (COVID-19) era. 2013 results from [8]; 2018 and 2019 results: not published data. HD: hospitalization day; VAP: ventilator-associated pneumonia; VD: ventilator day; CRI: catheter-related infection; CD: catheter day; UTI: urinary tract infection; BCD: bladder catheterization day; FI: fungal infection.

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  Figure 3. Distribution of microorganisms before and during corona virus disease 2019 (COVID-19) in percent (%). 2013 results from [8]; 2018 and 2019 results: not published data.

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