{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:58:42Z","timestamp":1793372322141,"version":"4.5.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To identify predictors of superinfections in COVID-19.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred \u226548\u2009h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19\u2009days (range 11\u201329.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5\u201339.5, P\u200a&amp;lt;\u200a0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4\u201313.1, P\u200a&amp;lt;\u200a0.001); immunomodulatory agents (tocilizumab\/baricitinib) (OR 5.09, 95% CI 2.2\u201311.8, P\u200a&amp;lt;\u200a0.001); C-reactive protein on admission &amp;gt;7\u2009mg\/dl (OR 3.59, 95% CI 1.7\u20137.7, P\u200a=\u200a0.001); and previous treatment with piperacillin\/tazobactam (OR 2.85, 95% CI 1.1\u20137.2, P\u200a=\u200a0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11\u2009days, P\u200a&amp;lt;\u200a0.001), while mortality rates were similar (18.8% versus 23.2%, P\u200a=\u200a0.445).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaa530","type":"journal-article","created":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T20:13:44Z","timestamp":1608063224000},"page":"1078-1084","source":"Crossref","is-referenced-by-count":126,"title":["Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3813-8796","authenticated-orcid":false,"given":"Marco","family":"Falcone","sequence":"first","affiliation":[{"name":"Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giusy","family":"Tiseo","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 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