Different Epidemiology of Bloodstream Infections in COVID-19 Compared to non-COVID-19 Critically ill Patients

A Descriptive Analysis of the Eurobact II Study

Niccolò Buetti; Alexis Tabah; Ambre Loiodice; Stéphane Ruckly; Abdullah Tarik Aslan; Giorgia Montrucchio; Andrea Cortegiani; Nese Saltoglu; Bircan Kayaaslan; Firdevs Aksoy; Akova Murat; Özlem Akdoğan; Kemal Tolga Saracoglu; Cem Erdogan; Marc Leone; Ricard Ferrer; José-Artur Paiva; Yoshiro Hayashi; Mahesh Ramanan; Andrew Conway Morris; François Barbier; Jean-François Timsit


Crit Care. 2022;26(319) 

In This Article

Abstract and Introduction


Background: The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients.

Methods: We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients' characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models.

Results: A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49–2.45).

Conclusions: We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality.

Trial Registration: ClinicalTrials.org number NCT03937245. Registered 3 May 2019.