AUTHOR=Chen Ziying , Zhan Qingyuan , Huang Linna , Wang Chen 

TITLE=Coinfection and superinfection in ICU critically ill patients with severe COVID-19 pneumonia and influenza pneumonia: are the pictures different?

JOURNAL=Frontiers in Public Health

VOLUME=11

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1195048

DOI=10.3389/fpubh.2023.1195048

ISSN=2296-2565

ABSTRACT=<sec id="sec1"><title>Background</title><p>Similar to influenza, coinfections and superinfections are common and might result in poor prognosis. Our study aimed to compare the characteristics and risks of coinfections and superinfections in severe COVID-19 and influenza virus pneumonia.</p></sec><sec id="sec2"><title>Methods</title><p>The data of patients with COVID-19 and influenza admitted to the intensive care unit (ICU) were retrospectively analyzed. The primary outcome was to describe the prevalence and pathogenic distribution of coinfections/ICU-acquired superinfections in the study population. The secondary outcome was to evaluate the independent risk factors for coinfections/ICU-acquired superinfections at ICU admission. Multivariate analysis of survivors and non-survivors was performed to investigate whether coinfections/ICU-acquired superinfections was an independent prognostic factor.</p></sec><sec id="sec3"><title>Results</title><p>In the COVID-19 (<italic>n</italic> = 123) and influenza (<italic>n</italic> = 145) cohorts, the incidence of coinfections/ICU-acquired superinfections was 33.3%/43.9 and 35.2%/52.4%, respectively. The most common bacteria identified in coinfection cases were <italic>Enterococcus faecium, Pseudomonas aeruginosa</italic>, <italic>and Acinetobacter baumannii</italic> (COVID-19 cohort) and <italic>A. baumannii, P. aeruginosa</italic>, <italic>and Klebsiella pneumoniae</italic> (influenza cohort). A significant higher proportion of coinfection events was sustained by <italic>Aspergillus</italic> spp. [(22/123, 17.9% in COVID-19) and (18/145, 12.4% in influenza)]. The COVID-19 group had more cases of ICU-acquired <italic>A. baumannii</italic>, <italic>Corynebacterium striatum</italic> and <italic>K. pneumoniae</italic>. <italic>A. baumannii</italic>, <italic>P. aeruginosa</italic>, and <italic>K. pneumoniae</italic> were the three most prevalent pathogens in the influenza cases with ICU-acquired superinfections. Patients with APACHE II ≥18, CD8+ T cells ≤90/μL, and 50 &lt; age ≤ 70 years were more susceptible to coinfections; while those with CD8+ T cells ≤90/μL, CRP ≥120 mg/L, IL-8 ≥ 20 pg./mL, blood glucose ≥10 mmol/L, hypertension, and smoking might had a higher risk of ICU-acquired superinfections in the COVID-19 group. ICU-acquired superinfection, corticosteroid administration for COVID-19 treatment before ICU admission, and SOFA score ≥ 7 were independent prognostic factors in patients with COVID-19.</p></sec><sec id="sec4"><title>Conclusion</title><p>Patients with COVID-19 or influenza had a high incidence of coinfections and ICU-acquired superinfections. The represent agents of coinfection in ICU patients were different from those in the general ward. These high-risk patients should be closely monitored and empirically treated with effective antibiotics according to the pathogen.</p></sec>