Background
Methods
Study design
Patients
Clinical variables and outcomes
Statistical analysis
Ethics
Results
Incidence of iGAS infection
Baseline characteristics of iGAS patients
Baseline characteristics | All patients (n = 222) | Before COVID-19 (n = 73) | After COVID-19 (n = 149) | p value |
---|---|---|---|---|
Male, n (%) | 128 (58%) | 41 (59%) | 87 (58%) | 0.753 |
Age (years), median (IQR) | 61 (43–70) | 62 (49–70) | 60 (42–69) | 0.265 |
BMI (kg/m2), median (IQR) | 26 (22.9–30.9) | 26 (23.3–32.3) | 25.9 (22.9–30.5) | 0.643 |
Hypertension, n (%) | 80 (36%) | 35 (48%) | 45 (30%) | 0.010 |
Diabetes, n (%) | 40 (18%) | 16 (22%) | 24 (13%) | 0.290 |
Coronary disease, n (%) | 23 (10%) | 13 (18%) | 10 (7%) | 0.011 |
Immunosuppression, n (%) | 16 (7%) | 7 (10%) | 9 (6%) | 0.337 |
Asthma, n (%) | 18 (8%) | 5 (7%) | 13 (8%) | 0.631 |
COPD, n (%) | 13 (6%) | 11 (15%) | 2 (1%) | < 0.001 |
Chronic kidney disease, n (%) | 14 (6%) | 9 (12%) | 5 (3%) | 0.003 |
Stroke, n (%) | 10 (5%) | 3 (4%) | 7 (5%) | 0.843 |
Active tobacco use, n (%) | 51 (23%) | 22 (30%) | 29 (19%) | 0.076 |
Alcohol use disorders, n (%) | 33 (15%) | 17 (23%) | 16 (11%) | 0.014 |
Prior NSAID use, n (%) | 31 (14%) | 11 (15%) | 20 (13%) | 0.740 |
Infection sites | 0.144 | |||
Skin and soft tissue, n (%) | 98 (44%) | 37 (51%) | 60 (40%) | |
Lower respiratory tract. n (%) | 75 (34%) | 18 (25%) | 57 (38%) | |
Others, n (%) | 49 (22%) | 16 (22%) | 33 (22%) | |
SOFA score at D1, median (IQR) | 8 (5–13) | 7 (5–10) | 9 (6–13) | 0.011 |
Cardiovascular, median (IQR) | 4 (1–4) | 4 (1–4) | 4 (1–4) | |
Renal, median (IQR) | 2 (0–3) | 1 (0–3) | 2 (0–3) | |
Respiration, median (IQR) | 2 (1–3) | 2 (0.5–2) | 2 (1–3) | |
Coagulation, median (IQR) | 1 (0–2) | 0 (0–1) | 1 (0–2) | |
Central nervous system, median (IQR) | 0 (0–1) | 0 (0–1) | 0 (0–1) | |
Liver, median (IQR) | 0 (0–1) | 0 (0–1) | 0 (0–1) | |
STSS, n (%) | 123 (55%) | 32 (45%) | 91 (61%) | 0.015 |
STSS with renal manifestations, n (%) | 119 (54%) | 33 (45%) | 86 (58%) | |
STSS with liver manifestations, n (%) | 88 (40%) | 20 (27%) | 68 (46%) | |
STSS with ARDS, n (%) | 79 (36%) | 15 (21%) | 64 (43%) | |
STSS with soft tissue necrosis, n (%) | 75 (34%) | 22 (30%) | 53 (36%) | |
STSS with coagulopathy manifestations, n (%) | 75 (34%) | 11 (15%) | 64 (43%) | |
Acute kidney injury, n (%) | 155 (70%) | 47 (64%) | 108 (76%) | 0.217 |
Ferritin (ng/mL)º, median (IQR) | 603 (371–1490) | 403 (312–597) | 763 (419–1704) | 0.013 |
Fibrinogen (mg/L)$, median (IQR) | 6.6 ± 2 | 6.5 ± 2.1 | 6.7 ± 2.0 | 0.445 |
Lymphocyte count (G/L)¤, median (IQR) | 0.37 (0.19–0.64) | 0.35 (0.21–0.61) | 0.37 (0.18–0.70) | 0.804 |
Neutrophil count (G/L)§, mean ± SD | 11.1 ± 8.3 | 13.8 ± 7.8 | 9.7 ± 8.2 | < 0.001 |
Albumin (g/L)‡, mean ± SD | 23.4 ± 6.8 | 22.9 ± 6.6 | 24 ± 7.1 | 0.284 |
COVID-19 co-infection, n (%) | 5 (2%) | 0 (0%) | 5 (3%) | 0.113 |
Influenza co-infection, n (%) | 33 (15%) | 2 (3%) | 31 (21%) | < 0.001 |
Others active viral co-infection, n (%) | 8 (4%) | 1 (1%) | 7 (5%) | 0.211 |
Treatment of iGAS patients
All patients (n = 222) | Before COVID-19 (n = 73) | After COVID-19 (n = 149) | p value | |
---|---|---|---|---|
Treatment of iGAS infections | ||||
Time between onset of symptoms and ICU admission (days), median (IQR) | 3 (1–4) | 2 (1–5) | 3 (1–4) | 0.438 |
Time between ICU admission and iGAS infection confirmed (days), median (IQR) | 0 (0–1) | 0 (0–1) | 0 (0–1) | 0.235 |
Empiric antimicrobial therapy at ICU admission, n (%) | 221 (100%) | 72 (99%) | 149 (100%) | 1 |
Time from ICU admission to effective antimicrobial therapy (days), median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0.235 |
Monotherapy, n (%) | 64 (29%) | 30 (41%) | 34 (23%) | 0.005 |
Double therapy, n (%) | 131 (59%) | 38 (52%) | 93 (62%) | 0.140 |
Triple therapy, n (%) | 26 (12%) | 5 (7%) | 21 (14%) | 0.115 |
Clindamycin use, n (%) | 124 (56%) | 30 (44%) | 94 (63%) | 0.001 |
Linezolid use, n (%) | 34 (15%) | 6 (6%) | 28 (19%) | 0.040 |
Intravenous immunoglobulin use, n (%) | 17 (8%) | 2 (3%) | 15 (10%) | 0.054 |
Surgical source control needed, n (%) | 90 (41%) | 27 (37%) | 63 (42%) | 0.450 |
Time from ICU admission to surgical source control (days), median (IQR) | 0 (0–1) | 0 (0–1) | 0 (0–1) | 0.965 |
Invasive mechanical ventilation, n (%) | 135 (61%) | 36 (49%) | 99 (66%) | 0.014 |
Length of intubation (days), median (IQR) | 7 (2–14) | 6 (3–15) | 8 (2–14) | 0.998 |
Norepinephrine use, n (%) | 164 (74%) | 50 (68%) | 114 (77%) | 0.173 |
Maximum norepinephrine dose (μg/kg/min), median (IQR) | 0.9 (0.4–2) | 0.6 (0.2–1.2) | 1.2 (0.5–2.1) | 0.002 |
Dobutamine use, n (%) | 23 (11%) | 4 (5%) | 19 (14%) | 0.065 |
Renal replacement therapy, n (%) | 57 (26%) | 17 (23%) | 40 (29%) | 0.569 |
Veno-arterial ECMO, n (%) | 3 (1%) | 1 (1%) | 2 (1%) | 0.987 |
Outcome of iGAS infections | ||||
ICU length of stay (days), median (IQR) | 7 (4–16) | 6 (4–16) | 8 (4–16) | 0.278 |
Hospitalization length of stay (days), median (IQR) | 22 (11–35) | 23 (9–37) | 22
(13–34) | 0.711 |
ICU death, n (%) | 43 (19%) | 10 (14%) | 33 (22%) | 0.135 |
Deaths at day 90, n (%) | 46 (21%) | 13 (18%) | 33 (22%) | 0.820 |
Time from ICU admission to death (days), median (IQR) | 2 (0–7) | 1 (1–3) | 2 (1–13) | 0.540 |
Outcomes of iGAS patients
Factors associated with ICU mortality in iGAS patients
Variables | Multivariate analysis | ||
---|---|---|---|
OR | CI95% | p value | |
Diabetes | 3.92 | 1.42–10.79 | 0.008 |
Immunosuppression | 4.02 | 1.03–15.59 | 0.044 |
STSS | 5.75 | 1.71–19.22 | 0.005 |
Invasive mechanical ventilation | 6.08 | 1.71–21.60 | 0.005 |
Acute kidney injury | 4.85 | 1.05–22.42 | 0.043 |
Mortality in STSS patients (n = 123)
Factors associated with ICU mortality in STSS patients
Discussion
Conclusion
Take-home message
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The incidence of iGAS infections requiring ICU admission by admission increased by 4 to 5-fold after the COVID-19 pandemic.
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After the COVID-19 pandemic, the rate of STSS was higher, with no significant increase in ICU mortality rate.