Bacterial infections in patients hospitalized with COVID-19
Authors: Moreno-Torres Víctor , de Mendoza Carmen , de la Fuente Sara , Sánchez Enrique , Martínez-Urbistondo María , Herráiz Jesús , Gutiérrez Andrea , Gutiérrez Ángela , Hernández Carlos , Callejas Alejandro , Maínez Carmen , Royuela Ana , Cuervas-Mons Valentín ,   the Puerta de Hierro COVID-19 working group, Fernández-Cruz A. , Múñez E. , de Molina R. Malo , Pintos I. , de Santiago A. Díaz , Ramos A. , Mills P. , Laguna P. , Vázquez G. , Valle M. , Muñoz A. , Cantos B. , Calderón J. , Ángel-Moreno A , Baños I. , Montero E , Carreño M. C. , Romero Y. , Muñoz R. , Durán P. , Mellor-Pita S. , Tutor P. , Aguilar M. , Díaz G. , García C. , Jara B. , Laporta R. , Lázaro M. T. , López C. , Mínguez P. , Trisán A. , Carabias R. , Erro M. , Agudo B. , Aller J. , Benlloch R. , Blasco M. R. , Brito M. A. , Calvo V. , Calvo M. , Campos J. , Cazorla R. , Cea M. , Cembrero H. , Colino E. , Córda S. , Cruz S. , Del Pozo G. , Del Pozo C. , Elosua M. , Espinosa M. , Fernández C. , Ferre C. , García-Espantaleón M. , García-Izquierdo E. A. , Gil B. , Gómez-Porro P. , González S. , González I. , Escalera G. , López A. I. , Losa A. , Marín M. E. , Martínez I. , Martínez M. E. , Maximiano C. , Méndez M. , Mingo S. , Mitroi C. , Núñez B. , Ortega P. , Oteo J. F. , Pérez N. , Prieto L. , Relea L. , Rodríguez G. , Sabín J. , Sáenz J. , Sánchez A. , Sánchez A. , Sanz J. , Segovia J. , Silva L. , Toquero J. , Velasco M. E. , Villaverde S. , Andrés A. , Blanco S. , Diego I. , Donate I. , Escudero G. , Expósito E. , Galán A. , García S. , Gómez J. , Gutiérrez A. , Edith V. , Gutiérrez I , Martínez F. , Mora A. , Morrás I. , Muñoz A. , Valencia A. , Vázquez J. M. , Arias A. , Bilbao J. , Duca A. M. , García-Viejo M. A. , Palau J. M. , Roldán A. , Castejón R. , Citores M. J. , Rosado S. , Vargas J. A. , Ussetti P 
Published: August 2021

AbstractBacterial infections may complicate the course of COVID-19 patients. The rate and predictors of bacterial infections were examined in patients consecutively admitted with COVID-19 at one tertiary hospital in Madrid between March 1st and April 30th, 2020. Among 1594 hospitalized patients with COVID-19, 135 (8.5%) experienced bacterial infectious events, distributed as follows: urinary tract infections (32.6%), bacteremia (31.9%), pneumonia (31.8%), intra-abdominal infections (6.7%) and skin and soft tissue infections (6.7%). Independent predictors of bacterial infections were older age, neurological disease, prior immunosuppression and ICU admission (p < 0.05). Patients with bacterial infections who more frequently received steroids and tocilizumab, progressed to lower Sap02/FiO2 ratios, and experienced more severe ARDS (p < 0.001). The mortality rate was significantly higher in patients with bacterial infections as compared to the rest (25% vs 6.7%, respectively; p < 0.001). In multivariate analyses, older age, prior neurological or kidney disease, immunosuppression and ARDS severity were associated with an increased mortality (p < 0.05) while bacterial infections were not. Conversely, the use of steroids or steroids plus tocilizumab did not confer a higher risk of bacterial infections and improved survival rates. Bacterial infections occurred in 8.5% of patients hospitalized with COVID-19 during the first wave of the pandemic. They were not independently associated with increased mortality rates. Baseline COVID-19 severity rather than the incidence of bacterial infections seems to contribute to mortality. When indicated, the use of steroids or steroids plus tocilizumab might improve survival in this population.