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Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU.

Identifieur interne : 001634 ( Main/Exploration ); précédent : 001633; suivant : 001635

Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU.

Auteurs : Damien Contou [France] ; Aurore Claudinon [France] ; Olivier Pajot [France] ; Maïté Micaëlo [France] ; Pascale Longuet Flandre [France] ; Marie Dubert [France] ; Radj Cally [France] ; Elsa Logre [France] ; Megan Fraissé [France] ; Hervé Mentec [France] ; Gaëtan Plantefève [France]

Source :

RBID : pubmed:32894364

Abstract

BACKGROUND

Data on the prevalence of bacterial and viral co-infections among patients admitted to the ICU for acute respiratory failure related to SARS-CoV-2 pneumonia are lacking. We aimed to assess the rate of bacterial and viral co-infections, as well as to report the most common micro-organisms involved in patients admitted to the ICU for severe SARS-CoV-2 pneumonia.

PATIENTS AND METHODS

In this monocenter retrospective study, we reviewed all the respiratory microbiological investigations performed within the first 48 h of ICU admission of COVID-19 patients (RT-PCR positive for SARS-CoV-2) admitted for acute respiratory failure.

RESULTS

From March 13th to April 16th 2020, a total of 92 adult patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 40-bed ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. Among them, 26 (28%) were considered as co-infected with a pathogenic bacterium at ICU admission with no co-infection related to atypical bacteria or viruses. The distribution of the 32 bacteria isolated from culture and/or respiratory PCRs was as follows: methicillin-sensitive Staphylococcus aureus (n = 10/32, 31%), Haemophilus influenzae (n = 7/32, 22%), Streptococcus pneumoniae (n = 6/32, 19%), Enterobacteriaceae (n = 5/32, 16%), Pseudomonas aeruginosa (n = 2/32, 6%), Moraxella catarrhalis (n = 1/32, 3%) and Acinetobacter baumannii (n = 1/32, 3%). Among the 24 pathogenic bacteria isolated from culture, 2 (8%) and 5 (21%) were resistant to 3rd generation cephalosporin and to amoxicillin-clavulanate combination, respectively.

CONCLUSIONS

We report on a 28% rate of bacterial co-infection at ICU admission of patients with severe SARSCoV-2 pneumonia, mostly related to Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Enterobacteriaceae. In French patients with confirmed severe SARSCoV-2 pneumonia requiring ICU admission, our results encourage the systematic administration of an empiric antibiotic monotherapy with a 3rd generation cephalosporin, with a prompt de-escalation as soon as possible. Further larger studies are needed to assess the real prevalence and the predictors of co-infection together with its prognostic impact on critically ill patients with severe SARS-CoV-2 pneumonia.


DOI: 10.1186/s13613-020-00736-x
PubMed: 32894364
PubMed Central: PMC7475952


Affiliations:


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<name sortKey="Dubert, Marie" sort="Dubert, Marie" uniqKey="Dubert M" first="Marie" last="Dubert">Marie Dubert</name>
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<p>
<b>BACKGROUND</b>
</p>
<p>Data on the prevalence of bacterial and viral co-infections among patients admitted to the ICU for acute respiratory failure related to SARS-CoV-2 pneumonia are lacking. We aimed to assess the rate of bacterial and viral co-infections, as well as to report the most common micro-organisms involved in patients admitted to the ICU for severe SARS-CoV-2 pneumonia.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>PATIENTS AND METHODS</b>
</p>
<p>In this monocenter retrospective study, we reviewed all the respiratory microbiological investigations performed within the first 48 h of ICU admission of COVID-19 patients (RT-PCR positive for SARS-CoV-2) admitted for acute respiratory failure.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>From March 13th to April 16th 2020, a total of 92 adult patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 40-bed ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. Among them, 26 (28%) were considered as co-infected with a pathogenic bacterium at ICU admission with no co-infection related to atypical bacteria or viruses. The distribution of the 32 bacteria isolated from culture and/or respiratory PCRs was as follows: methicillin-sensitive Staphylococcus aureus (n = 10/32, 31%), Haemophilus influenzae (n = 7/32, 22%), Streptococcus pneumoniae (n = 6/32, 19%), Enterobacteriaceae (n = 5/32, 16%), Pseudomonas aeruginosa (n = 2/32, 6%), Moraxella catarrhalis (n = 1/32, 3%) and Acinetobacter baumannii (n = 1/32, 3%). Among the 24 pathogenic bacteria isolated from culture, 2 (8%) and 5 (21%) were resistant to 3rd generation cephalosporin and to amoxicillin-clavulanate combination, respectively.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>We report on a 28% rate of bacterial co-infection at ICU admission of patients with severe SARSCoV-2 pneumonia, mostly related to Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Enterobacteriaceae. In French patients with confirmed severe SARSCoV-2 pneumonia requiring ICU admission, our results encourage the systematic administration of an empiric antibiotic monotherapy with a 3rd generation cephalosporin, with a prompt de-escalation as soon as possible. Further larger studies are needed to assess the real prevalence and the predictors of co-infection together with its prognostic impact on critically ill patients with severe SARS-CoV-2 pneumonia.</p>
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<Volume>10</Volume>
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<Month>Sep</Month>
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<ELocationID EIdType="doi" ValidYN="Y">10.1186/s13613-020-00736-x</ELocationID>
<Abstract>
<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Data on the prevalence of bacterial and viral co-infections among patients admitted to the ICU for acute respiratory failure related to SARS-CoV-2 pneumonia are lacking. We aimed to assess the rate of bacterial and viral co-infections, as well as to report the most common micro-organisms involved in patients admitted to the ICU for severe SARS-CoV-2 pneumonia.</AbstractText>
<AbstractText Label="PATIENTS AND METHODS" NlmCategory="METHODS">In this monocenter retrospective study, we reviewed all the respiratory microbiological investigations performed within the first 48 h of ICU admission of COVID-19 patients (RT-PCR positive for SARS-CoV-2) admitted for acute respiratory failure.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">From March 13th to April 16th 2020, a total of 92 adult patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 40-bed ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. Among them, 26 (28%) were considered as co-infected with a pathogenic bacterium at ICU admission with no co-infection related to atypical bacteria or viruses. The distribution of the 32 bacteria isolated from culture and/or respiratory PCRs was as follows: methicillin-sensitive Staphylococcus aureus (n = 10/32, 31%), Haemophilus influenzae (n = 7/32, 22%), Streptococcus pneumoniae (n = 6/32, 19%), Enterobacteriaceae (n = 5/32, 16%), Pseudomonas aeruginosa (n = 2/32, 6%), Moraxella catarrhalis (n = 1/32, 3%) and Acinetobacter baumannii (n = 1/32, 3%). Among the 24 pathogenic bacteria isolated from culture, 2 (8%) and 5 (21%) were resistant to 3rd generation cephalosporin and to amoxicillin-clavulanate combination, respectively.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">We report on a 28% rate of bacterial co-infection at ICU admission of patients with severe SARSCoV-2 pneumonia, mostly related to Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Enterobacteriaceae. In French patients with confirmed severe SARSCoV-2 pneumonia requiring ICU admission, our results encourage the systematic administration of an empiric antibiotic monotherapy with a 3rd generation cephalosporin, with a prompt de-escalation as soon as possible. Further larger studies are needed to assess the real prevalence and the predictors of co-infection together with its prognostic impact on critically ill patients with severe SARS-CoV-2 pneumonia.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y">
<Author ValidYN="Y">
<LastName>Contou</LastName>
<ForeName>Damien</ForeName>
<Initials>D</Initials>
<AffiliationInfo>
<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France. damien.contou@ch-argenteuil.fr.</Affiliation>
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<LastName>Claudinon</LastName>
<ForeName>Aurore</ForeName>
<Initials>A</Initials>
<AffiliationInfo>
<Affiliation>Service de Microbiologie, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Pajot</LastName>
<ForeName>Olivier</ForeName>
<Initials>O</Initials>
<AffiliationInfo>
<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Micaëlo</LastName>
<ForeName>Maïté</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Service de Microbiologie, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
</AffiliationInfo>
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<LastName>Longuet Flandre</LastName>
<ForeName>Pascale</ForeName>
<Initials>P</Initials>
<AffiliationInfo>
<Affiliation>Equipe Mobile de Maladies Infectieuses, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
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</Author>
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<LastName>Dubert</LastName>
<ForeName>Marie</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Service de Maladies Infectieuses Et Tropicales, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, 46, rue Henri Huchard, 75018, Paris, France.</Affiliation>
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<ForeName>Radj</ForeName>
<Initials>R</Initials>
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<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
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<LastName>Logre</LastName>
<ForeName>Elsa</ForeName>
<Initials>E</Initials>
<AffiliationInfo>
<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
</AffiliationInfo>
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<LastName>Fraissé</LastName>
<ForeName>Megan</ForeName>
<Initials>M</Initials>
<AffiliationInfo>
<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
</AffiliationInfo>
</Author>
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<LastName>Mentec</LastName>
<ForeName>Hervé</ForeName>
<Initials>H</Initials>
<AffiliationInfo>
<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
</AffiliationInfo>
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<LastName>Plantefève</LastName>
<ForeName>Gaëtan</ForeName>
<Initials>G</Initials>
<AffiliationInfo>
<Affiliation>Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.</Affiliation>
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<Language>eng</Language>
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<PublicationType UI="D016428">Journal Article</PublicationType>
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<ArticleDate DateType="Electronic">
<Year>2020</Year>
<Month>09</Month>
<Day>07</Day>
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<Country>Germany</Country>
<MedlineTA>Ann Intensive Care</MedlineTA>
<NlmUniqueID>101562873</NlmUniqueID>
<ISSNLinking>2110-5820</ISSNLinking>
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<Keyword MajorTopicYN="N">Bacteria</Keyword>
<Keyword MajorTopicYN="N">COVID-19</Keyword>
<Keyword MajorTopicYN="N">Co-infection</Keyword>
<Keyword MajorTopicYN="N">Haemophilus influenzae</Keyword>
<Keyword MajorTopicYN="N">SARS-CoV-2</Keyword>
<Keyword MajorTopicYN="N">Staphylococcus aureus</Keyword>
<Keyword MajorTopicYN="N">Streptococcus pneumoniae</Keyword>
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<Month>05</Month>
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<Year>2020</Year>
<Month>08</Month>
<Day>30</Day>
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<Month>9</Month>
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