Critically Ill COVID-19 Patients Are at High Risk for Hospital-Acquired Infections

hospital beds in the hospital hallway
hospital beds in the hospital hallway
Critically ill patients with COVID-19 are at high risk for hospital-acquired infections, particularly ventilator-associated pneumonias and bloodstream infections.

Critically ill patients with COVID-19 are at high risk for hospital-acquired infections (HAIs), particularly ventilator-associated pneumonias (VAPs) and bloodstream infections (BSIs), and therefore clinicians should make every effort to implement protocols for surveillance and prevention of infectious complications, according to study results published in CHEST.

Few small studies have described HAIs during COVID-19; therefore, researchers sought to determine the characteristics associated with HAIs and how HAIs relate to outcomes in critically ill patients with COVID-19. The researchers conducted a retrospective analysis of prospectively collected data in adult patients with severe COVID-19 admitted to the intensive care units (ICU) of 8 Italian hospitals between February 20, 2020, and May 20, 2020 ( Identifier: NCT04388670).

Among 774 patients, 359 (46%) patients developed 759 HAIs (44.7 infections/1000 ICU patient-days), 35% of which were caused by multidrug resistant (MDR) bacteria. Ventilator-associated pneumonias (n=389; 51%), BSIs (n=257; 34%), and catheter-related bloodstream infections (CRBSIs; n=74; 10%) were the most frequent HAIs, with 26.0 VAPs per 1000 patient intubation-days, 11.7 BSIs per 1000 ICU patient-days, and 4.7 CRBSIs per 1000 patient-days.

Gram-negative bacteria (especially Enterobacterales) and Staphylococcus aureus caused 64% and 28% of VAPs, respectively. Variables independently associated with infection were age, positive end-expiratory pressure (PEEP), and treatment with broad-spectrum antibiotic at admission. A total of 234 (30%) patients died in the ICU (15.3 deaths/1000 ICU patient-days). Patients with HAIs complicated by septic shock had almost doubled mortality (52% vs 29%), but noncomplicated infections did not affect mortality. Hospital-acquired infections prolonged mechanical ventilation (24 vs 9 days; P <.001), and ICU (24 vs 9 days; P= .003) and hospital stays (42 vs 23 days; P <.001).

“Critically ill COVID-19 patients are at high risk for HAIs, especially VAP and BSIs, frequently caused by [MDR] bacteria,” the study authors wrote. “Patients with HAIs complicated by shock had almost doubled mortality, and infected patients had prolonged [invasive mechanical ventilation] and hospitalization.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Grasselli G, Scaravilli V, Mangioni D, et al. Hospital-acquired infections in critically-ill COVID-19 patients. CHEST. Published online April 20, 2021. doi:10.1016/j.chest.2021.04.002