Scientific article
Open access

COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network

Published inIntensive care medicine, vol. 47, no. 2, p. 180-187
  • The original version of this article, published on January 27, 2021, contained a mistake. The spelling of Shidasp Siami’s name was incorrect. The original article has been corrected. The authors apologize for the mistake.
  • DOI : 10.1007/s00134-021-06379-1
  • PMID : 33688994
Publication date2021-02
First online date2021-01-27

Purpose: The primary objective of this study was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Subsequently, we performed secondary analyses in order to explain the observed results.

Methods: We conducted a matched case-cohort study, based on prospectively collected data from a large ICU cohort in France. Critically ill COVID-19 patients were matched with similar non-COVID-19 patients. ICU-BSI was defined by an infection onset occurring > 48 h after ICU admission. We estimated the effect of COVID-19 on the probability to develop an ICU-BSI using proportional subdistribution hazards models.

Results: We identified 321 COVID-19 patients and 1029 eligible controls in 6 ICUs. Finally, 235 COVID-19 patients were matched with 235 non-COVID-19 patients. We observed 43 ICU-BSIs, 35 (14.9%) in the COVID-19 group and 8 (3.4%) in the non-COVID-19 group (p ≤ 0.0001), respectively. ICU-BSIs of COVID-19 patients were more frequently of unknown source (47.4%). COVID-19 patients had an increased probability to develop ICU-BSI, especially after 7 days of ICU admission. Using proportional subdistribution hazards models, COVID-19 increased the daily risk to develop ICU-BSI (sHR 4.50, 95% CI 1.82-11.16, p = 0.0012). Among COVID-19 patients (n = 235), a significantly increased risk for ICU-BSI was detected in patients who received tocilizumab or anakinra (sHR 3.20, 95% CI 1.31-7.81, p = 0.011) but not corticosteroids.

Conclusions: Using prospectively collected multicentric data, we showed that the ICU-BSI risk was higher for COVID-19 than non-COVID-19 critically ill patients after seven days of ICU stay. Clinicians should be particularly careful on late ICU-BSIs in COVID-19 patients. Tocilizumab or anakinra may increase the ICU-BSI risk.

  • Bloodstream infection
  • COVID-19
  • Hospital-acquired
  • ICU
  • SARS-CoV-2
  • Aged
  • COVID-19 / complications
  • Cohort Studies
  • Cross Infection / epidemiology
  • Female
  • France / epidemiology
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk Factors
  • Sepsis / epidemiology
Citation (ISO format)
BUETTI, Niccolo et al. COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network. In: Intensive care medicine, 2021, vol. 47, n° 2, p. 180–187. doi: 10.1007/s00134-021-06346-w
Main files (1)
Article (Published version)
Secondary files (3)
ISSN of the journal0342-4642

Technical informations

Creation09/07/2022 12:31:12 PM
First validation05/12/2023 2:51:08 PM
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