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Research Article Open Access

The Duration of Mechanical Ventilation is the Main Cause of Bacterial/Fungal Superinfection in Critically Ill Patients with COVID-19 at Altitude

  • 1Intensive Care Unit Hospital de San José, Foundation University of Sciences Health, Clinica Cobos Medical Centre, CIMCA-GRIBOS Research Group, Bogotá, Colombia
  • 2Critical Care Department, Hospital del Mar, Barcelona, Spain; GREPAC, Instituto Hospital del Mar de Investigaciones Médicas (IMIM); Departamento de Medicina (MELIS), Universitat Pompeu Fabra (UPF), Barcelona, Spain
  • 3Intensive Care Unit, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
  • 4Instructor Associated, Intensive Care Unit Hospital de San José, Foundation University of Sciences Health, CIMCA Research Centre, Bogotá, Colombia
  • 5Intensive Care Unit Hospital de San José, Foundation University of Sciences Health, CIMCA Research Centre, Bogotá, Colombia
  • 6Université Laval, Faculté de Médecine, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada
  • 7High-Altitude Brain Recherche Center (HABRC). Bolivian Hypoxia Recherche Institute, La Paz, Bolivia
+ Affiliations - Affiliations

Corresponding Author

Soliz Soliz, jorge.soliz@criucpq.ulaval.ca

Received Date: November 11, 2022

Accepted Date: November 24, 2022

Abstract

Background. COVID-19 patients in intensive care units suffer from bacterial/fungal superinfections. However, the incidence and cause of such superinfections in high-altitude hospitals remain poorly investigated.

Objectives. The aim of this study was to evaluate the frequency of bacterial/fungal superinfection in patients with COVID-19 hospitalized in the intensive care unit (ICU) of the Hospital Universitario San José de Bogotá, Colombia, located at an altitude of 2,651 meters above sea level (high altitude). The impact of corticosteroids on the development of infection was also evaluated.

Methods. The cohort included 279 patients, of which 188 (67.4%) were male, 116 (42.3%) were treated with dexamethasone, and 48 (17.2%) were diagnosed with superinfection. A retrospective descriptive cohort study was performed to evaluate the association between bacterial/fungal superinfection frequency, corticosteroid treatment, mechanical ventilation, and mortality rate.

Results. Our results showed that bacteremia was the most frequent diagnosis (n=20; 41.6%) of patients with superinfection, followed by pulmonary superinfection (n=17; 35.4%). The most frequently identified causative agents of superinfection were K. pneumoniae (n=23; 26.1%), C. albicans (n=10; 11.4%) and P. aeruginosa (n=8; 9.1%). Moreover, our results showed no association between corticosteroid treatment (or the use of empiric antibiotic treatment) and mortality. However, we found a significant association between bacterial/fungal superinfection and the number of days on mechanical ventilation. However, bacterial/fungal superinfection showed no impact on the mortality rate. 

Conclusions. We conclude that bacterial/fungal superinfection in ICU highland patients with SARS-CoV-2 treated at Hospital Universitario San José in Bogotá, Colombia, increases mainly in proportion to the time required for mechanical ventilation.

Keywords

SARS-CoV-2, ICU, Corticosteroids, Co-infection, Bacterial, Fungal

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