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IRIS
Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set
Conway Morris, Andrew;Kohler, Katharina;De Corte, Thomas;Ercole, Ari;De Grooth, Harm-Jan;Elbers, Paul W G;Povoa, Pedro;Morais, Rui;Koulenti, Despoina;Jog, Sameer;Nielsen, Nathan;Jubb, Alasdair;Cecconi, Maurizio;De Waele, Jan;Marco Bezzi;Alicia Gira;Philipp Eller;Tarikul Hamid;Injamam Ull Haque;Wim De Buyser;Antonella Cudia;Daniel De Backer;Pierre Foulon;Vincent Collin;Jan De Waele;Jolien Van Hecke;Elisabeth De Waele;Claire Van Malderen;Jean-Baptiste Mesland;Patrick Biston;Michael Piagnerelli;Lionel Haentjens;Nicolas De Schryver;Jan Van Leemput;Philippe Vanhove;Pierre Bulpa;Viktoria Ilieva;David Katz;Alexandra Binnie;Anna Geagea;Fernando Tirapegui;Gustavo Lago;Jerónimo Graf;Rodrigo Perez-Araos;Patricio Vargas;Felipe Martinez;Eduardo Labarca;Daniel Molano Franco;Daniela Parra-Tanoux;Luis Felipe Reyes;David Yepes;Filip Periš;Sanda Stojanović Stipić;Cynthia Vanessa Campozano Burgos;Paulo Roberto Navas Boada;Jose Luis Barberan Brun;Juan Pablo Paredes Ballesteros;Gamal Abdelnasser;Ahmed Hammouda;Omar Elmandouh;Ahmed Azzam;Aliae Mohamed Hussein;Islam Galal;Ahmed K Awad;Mohammed A Azab;Maged Abdalla;Hebatallah Assal;Mostafa Alfishawy;Sherief Ghozy;Samar Tharwat;Abdullah Eldaly;Anneli Ellervee;Veronika Reinhard;Anne Chrisment;Chrystelle Poyat;Julio Badie;Fernando Berdaguer Ferrari;Björn Weiss;Clara Schellenberg;Julius J Grunow;Marco Lorenz;Stefan J Schaller;Peter Spieth;Marc Bota;Falk Fichtner;Kristina Fuest;Tobias Lahmer;Johannes Herrmann;Patrick Meybohm;Nikolaos Markou;Georgia Vasileiadou;Evangelia Chrysanthopoulou;Panagiotis Papamichalis;Ioanna Soultati;Sameer Jog;Kushal Kalvit;Sheila Nainan Myatra;Ivan Krupa;Aisa Tharwat;Alistair Nichol;Aine McCarthy;Ata Mahmoodpoor;Tommaso Tonetti;Paolo Isoni;Savino Spadaro;Carlo Alberto Volta;Lucia Mirabella;Alberto Noto;Gaetano Florio;Amedeo Guzzardella;Chiara Paleari;Federica Baccanelli;Marzia Savi;Massimo Antonelli;Gennaro De Pascale;San Luca;Barbara Vaccarini;Giorgia Montrucchio;Gabriele Sales;Katia Donadello;Leonardo Gottin;Marta Nizzero;Enrico Polati;Silvia De Rosa;Demet Sulemanji;Abdurraouf Abusalama;Muhammed Elhadi;Montelongo De FelipeJesus;Daniel Rodriguez Gonzalez;Victor Hugo Madrigal Robles;Nancy Canedo;Alejandro Esquivel Chavez;Tarek Dendane;Bart Grady;Ben de Jong;Eveline van der Heiden;Patrick Thoral;Bas van den Bogaard;Peter E Spronk;Sefanja Achterberg;Melanie Groeneveld;Ralph K L So;Calvin de Wijs;Harm Scholten;Albertus Beishuizen;Alexander D Cornet;Auke C Reidinga;Hetty Kranen;Roos Mensink;Spaarne Gasthuis;Sylvia den Boer;Marcel de Groot;Oliver Beck;Carina Bethlehem;Bas van Bussel;Tim Frenzel;Celestine de Jong;Rob Wilting;Jozef Kesecioglu;Jannet Mehagnoul-Schipper;Datonye Alasia;Ashok Kumar;Ahad Qayyum;Muhammad Rana;Mustafa Abu Jayyab;Rosario Quispe Sierra;Aaron Mark Hernandez;José de Almeida;Lúcia Taborda;Mónica Anselmo;Tiago Ramires;Catarina Silva;Carolina Roriz;Rui Morais;Pedro Póvoa;Patricia Patricio;André Pinto;Maria Lurdes Santos;Vasco Costa;Pedro Cunha;Celina Gonçalves;Sandra Nunes;João Camões;Diana Adrião;Ana Oliveira;Ali Omrani;Muna Al Maslamani;Abdurrahmaan Suei Elbuzidi;Bara Mahmoud Al Qudah;Abdel Rauof Akkari;Mohamed Alkhatteb;Anas Baiou;Ahmed Husain;Mohamed Alwraidat;Ibrahim Abdulsalam Saif;Dana Bakdach;Amna Ahmed;Mohamed Aleef;Awadh Bintaher;Cristina Petrisor;Evgeniy Popov;Ksenia Popova;Mariia Dementienko;Boris Teplykh;Alexey Pyregov;Liubov Davydova;Belskii Vladislav;Elena Neporada;Ivan Zverev;Svetlana Meshchaninova;Dmitry Sokolov;Elena Gavrilova;Irina Shlyk;Igor Poliakov;Marina Vlasova;Ohoud Aljuhani;Amina Alkhalaf;Felwa Bin Humaid;Yaseen Arabi;Ahmed Kuhail;Omar Elrabi;Madihah E Ghannam;Ng Teng Fong;Amit Kansal;Vui Kian Ho;Jensen Ng;Raquel Rodrígez García;Xiana Taboada Fraga;Mª Del Pilar García-Bonillo;Antonio Padilla-Serrano;Marta Martin Cuadrado;Carlos Ferrando;Ignacio Catalan-Monzon;Laura Galarza;Fernando Frutos-Vivar;Jorge Jimenez;Carmen Rodríguez-Solis;Enric Franquesa-Gonzalez;Guillermo Pérez Acosta;Luciano Santana Cabrera;Juan Pablo Aviles Parra;Francisco Muñoyerro Gonzalez;Maria Del Carmen Lorente Conesa;Ignacio Yago Martinez Varela;Orville Victoriano Baez Pravia;Maria Cruz Martin Delgado;Carlos Munoz de Cabo;Ana-Maria Ioan;Cesar Perez-Calvo;Arnoldo Santos;Ane Abad-Motos;Javier Ripolles-Melchor;Belén Civantos Martin;Santiago Yus Teruel;Juan Higuera Lucas;Aaron Blandino Ortiz;Raúl de Pablo Sánchez;Jesús Emilio Barrueco-Francioni;Lorena Forcelledo Espina;José M Bonell-Goytisolo;Iñigo Salaverria;Antonia Socias Mir;Emilio Rodriguez-Ruiz;Virginia Hidalgo Valverde;Patricia Jimeno Cubero;Francisca Arbol Linde;Nieves Cruza Leganes;Juan Maria Romeu;Pablo Concha;José Angel Berezo-Garcia;Virginia Fraile;Cristina Cuenca-Rubio;David Pérez-Torres;Ainhoa Serrano;Clara Martínez Valero;Andrea Ortiz Suner;Leire Larrañaga;Noemi Legaristi;Gerardo Ferrigno;Safa Khlafalla;Rosita Bihariesingh-Sanchit;Hallands Sjukhus;Frank Zoerner;Jonathan Grip;Kristina Kilsand;Johan Mårtensson;Jonas Österlind;Akademiska Sjukhuset;Magnus von Seth;Västerviks Sjukhus;Johan Berkius;Samuele Ceruti;Andrea Glotta;Seval Izdes;Işıl Özkoçak Turan;Ahmet Cosar;Burcin Halacli;Necla Dereli;Mehmet Yilmaz;Türkay Akbas;Gülseren Elay;Selin Eyüpoğlu;Yelíz Bílír;Kemal Tolga Saraçoğlu;Ebru Kaya;Ayca Sultan Sahin;Pervin Korkmaz Ekren;Tuğçe Mengi;Kezban Ozmen Suner;Yakup Tomak;Ahmet Eroglu;Asad Alsabbah;Katie Hanlon;Kevin Gervin;Sean McMahon;Samantha Hagan;Caroline V Higenbottam;Randeep Mullhi;Lottie Poulton;Tomasz Torlinski;Allen Gareth;Nick Truman;Gopal Vijayakumar;Chris Hall;Alasdair Jubb;Lenka Cagova;Nicola Jones;Sam Graham;Nicole Robin;Amanda Cowton;Adrian Donnelly;Natalia Singatullina;Melanie Kent;Carole Boulanger;Zoë Campbell;Elizabeth Potter;Natalie Duric;Tamas Szakmany;Royal Brompton;Orinta Kviatkovske;Nandor Marczin;Caroline Ellis;Rajnish Saha;Chunda Sri-Chandana;John Allan;Lana Mumelj;Harish Venkatesh;Vera Nina Gotz;Anthony Cochrane;Barbara Ficial;Shruthi Kamble;Nuttha Lumlertgul;Christopher Oddy;Susan Jain;Giulia Beatrice Crapelli;Aikaterini Vlachou;David Golden;Sweyn Garrioch;Jeremy Henning;Gupta Loveleena;Miriam Davey;Lina Grauslyte;Erika Salciute-Simene;Martin Cook;Danny Barling;Phil Broadhurst;Sarah Purvis;Michael Spivey;Benjamin Shuker;Irina Grecu;Daniel Harding;Natalia Singatullina;James T Dean;Nathan D Nielsen;Sama Al-Bayati;Mohammed Al-Sadawi;Mariane Charron;Peter Stubenrauch;Jairo Santanilla;Catherine Wentowski;Dorothea Rosenberger;Polikseni Eksarko;Randeep Jawa
2022-01-01
Abstract
Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11572/364508
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.