Objective

To understand the impact of COVID-19 on the pathogen spectrum in critically ill patients.

Method

A retrospective study of COVID-19 ICU patients requiring invasive mechanical ventilation (IMV) or high-flow nasal cannula (HFNC), 2022/1 ~ 2022/8. 

Results

Consecutive 144 cases were studied. Deducting 12 with ICU stay < 2 days, 132 were examed for secondary infection within 30 days.

At ICU admission, there were 132 (92%) cases had both sputum and blood cultures, 100 (69%) had urine culture, 112 (78%) had Pneumococcus & Legionella urine antigen, 81 (56%) had M. pneumoniae IgM, 52 (36%) had sputum M. tuberculosis cultures. 

Among HFNC group, 3 (5.7%) developed nosocomial pneumonia. And 37 (46.8%) IMV patients got VAP, 14 (37.8%) were newly developed MDRO infections. 

Other HAI included 5 (3.8%) bloodstream infections, 10 (7.5%) urinary tract infections, 4  aspergillosis, 1 Pneumocystis pneumonia, 1 CMV viremia.

Conclusion

The most common pathogens of co-infection pneumonia are K. pneumoniae and P. aeruginosa. Secondary pneumonia is frequent in IMV patients. Carbapenem-resistant Gram-negative bacteria are the substantial threats.