Co-infections in critically ill adults with severe acute respiratory syndrome coronavirus 2 infection: an Italian multi-center prospective study.

Background: To date, few studies have described Hospital-acquired infections (HAIs) during COVID-19 outbreak. To examine the incidence of HAIs in critically ill adult patients with SARS-CoV-2 infection and to observe risk factors, and the impact on outcome of HAI.

Methods: A prospective multicenter study was conducted that included adult patients with SARS-CoV-2 infection admitted to 18 Italian Intensive Care Units from September 2020 to November 2021.

Results: A total of 589 patients were included. A total of 233 patients were diagnosed with at least one HAI (39.6%). The co-infection/co-colonization rate >48 hours after admission was 31.0 per 1000 person-days (95% CI 18.8-34.8). Age, length of ICU stay >7 days, obesity, type 2 diabetes mellitus, cardiovascular disease, inserted central venous catheter, intubation, APACHE II score >25, mechanical ventilation (MV) >48 hours, obesity and inserted urinary catheter are associated outcomes for infection acquisition. The overall mortality rate of patients was found to be significantly higher in patients who had acquired a HAI (RR=4.37; 95% CI 3.30-5.78; P<0.001).

Conclusions: Associated factors for HAI acquisition and mortality in ICU patients were identified and cause for revision of existing infection control policies.