ICU-Acquired Superinfections Before And During The COVID-19 Pandemic: Similarities And Differences

Background: During the COVID-19 pandemic, intensive care units (ICUs) experienced a surge in patients with viral pneumonia, often leading to acute respiratory failure. A global rise in ICU superinfections was observed; however, it remains unclear whether the extensive use of broad-spectrum antibiotics, corticosteroids, and immunosuppressants contributed to this rise. Objectives: We aim to identify clinical factors associated with these superinfections while analyzing epidemiologic patterns of superinfections in two different periods. Methods: We conducted a retrospective study comparing ICU patients admitted between January 2016 and December 2018 (control group) with those admitted due to hypoxemic respiratory failure from SARS-CoV-2 between September 2020 and February 2022. Clinical characteristics were analyzed after propensity score matching, and a subsequent multivariate analysis was conducted on the COVID-19 population to identify independent risk factors for superinfections. Results: 1456 patients were identified in the pre-COVID group and 164 in the COVID-19 group. The mean age was similar (64 years), but the pre-COVID-19 group was sicker. After matching, 427 pre-COVID-19 and 163 COVID19 patients were analyzed. COVID-19 patients experienced higher superinfection rates (42 % vs. 12 %, p < 0.001), were more obese, and had greater exposure to antibiotics and corticosteroids. After multivariate analysis of the COVID-19 population, ICU length of stay (OR=1.09, p = 0.01) and mechanical ventilation (OR=5.05, p = 0.008) were independent risk factors for superinfections. Conclusion: Increased superinfection rates in COVID-19 patients were linked to mechanical ventilation and prolonged ICU stays, potentially influenced by MDR infections linked to antibiotics and corticosteroids. Further investigations are needed to establish causality.