{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:43:31Z","timestamp":1771854211181,"version":"3.50.1"},"reference-count":98,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T00:00:00Z","timestamp":1708041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009553","name":"Czech Health Research Council","doi-asserted-by":"publisher","award":["NU22-B-112"],"award-info":[{"award-number":["NU22-B-112"]}],"id":[{"id":"10.13039\/501100009553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009553","name":"Czech Health Research Council","doi-asserted-by":"publisher","award":["LX22NPO5103"],"award-info":[{"award-number":["LX22NPO5103"]}],"id":[{"id":"10.13039\/501100009553","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009553","name":"Czech Health Research Council","doi-asserted-by":"publisher","award":["DRO FNOL 00098892"],"award-info":[{"award-number":["DRO FNOL 00098892"]}],"id":[{"id":"10.13039\/501100009553","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Union","award":["NU22-B-112"],"award-info":[{"award-number":["NU22-B-112"]}]},{"name":"European Union","award":["LX22NPO5103"],"award-info":[{"award-number":["LX22NPO5103"]}]},{"name":"European Union","award":["DRO FNOL 00098892"],"award-info":[{"award-number":["DRO FNOL 00098892"]}]},{"name":"MH CZ","award":["NU22-B-112"],"award-info":[{"award-number":["NU22-B-112"]}]},{"name":"MH CZ","award":["LX22NPO5103"],"award-info":[{"award-number":["LX22NPO5103"]}]},{"name":"MH CZ","award":["DRO FNOL 00098892"],"award-info":[{"award-number":["DRO FNOL 00098892"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and\/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).<\/jats:p>","DOI":"10.3390\/antibiotics13020192","type":"journal-article","created":{"date-parts":[[2024,2,16]],"date-time":"2024-02-16T08:02:17Z","timestamp":1708070537000},"page":"192","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19\u2014A Prospective Monocentric Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5354-8684","authenticated-orcid":false,"given":"Lenka","family":"Doubravsk\u00e1","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248\/7, 779 00 Olomouc, Czech Republic"},{"name":"Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miroslava","family":"Htoutou Sedl\u00e1kov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospital Olomouc, Zdravotniku 248\/7, 779 00 Olomouc, Czech Republic"},{"name":"Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate\u0159ina","family":"Fi\u0161erov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospital Olomouc, Zdravotniku 248\/7, 779 00 Olomouc, Czech Republic"},{"name":"Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Klementov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248\/7, 779 00 Olomouc, Czech Republic"},{"name":"Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radovan","family":"Turek","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate\u0159ina","family":"Langov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4621-8868","authenticated-orcid":false,"given":"Milan","family":"Kol\u00e1\u0159","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University Hospital Olomouc, Zdravotniku 248\/7, 779 00 Olomouc, Czech Republic"},{"name":"Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,16]]},"reference":[{"key":"ref_1","unstructured":"(2023, August 28). Coronavirus Disease 2019 (COVID-19) Treatment Guidelines, Available online: https:\/\/covid19treatmentguidelines.nih.gov."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_3","unstructured":"ARDS Definition Task Force, Ranieri, V.M., Rubenfeld, G.D., Thompson, B.T., Ferguson, N.D., Caldwell, E., Fan, E., Camporota, L., and Slutsky, A.S. (2012). Acute respiratory distress syndrome: The Berlin Definition. JAMA, 307, 2526\u20132533."},{"key":"ref_4","unstructured":"World Health Organization (WHO) (2023, May 21). Clinical Management of COVID-19: Living Guideline. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-clinical-2023.2."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1001\/jama.2020.2648","article-title":"Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72,314 Cases from the Chinese Center for Disease Control and Prevention","volume":"323","author":"Wu","year":"2020","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1186\/s13613-021-00820-w","article-title":"Intensive care management of patients with COVID-19: A practical approach","volume":"11","author":"Hajjar","year":"2021","journal-title":"Ann. Intensive Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/S2213-2600(20)30161-2","article-title":"Intensive care management of coronavirus disease 2019 (COVID-19): Challenges and recommendations","volume":"8","author":"Phua","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1001\/jama.2020.4031","article-title":"Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Abate, S.M., Ahmed, A.S., Mantfardo, B., and Basu, B. (2020). Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0235653"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1164\/rccm.202004-1385ED","article-title":"Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology","volume":"202","author":"Wunsch","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"298","DOI":"10.4266\/acc.2022.01123","article-title":"Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: A retrospective comparison of characteristics and outcomes","volume":"38","author":"Johnson","year":"2023","journal-title":"Acute Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e06813","DOI":"10.1016\/j.heliyon.2021.e06813","article-title":"Respiratory Supports Of COVID-19 Patients in Intensive Care Unit: A Systematic Review","volume":"7","author":"Ouyang","year":"2021","journal-title":"Heliyon"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1007\/s00134-023-07161-1","article-title":"Procalcitonin And C-Reactive Protein to Rule Out Early Bacterial Coinfection In COVID-19 Critically Ill Patients","volume":"49","author":"Galli","year":"2023","journal-title":"Intensive Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41479-021-00083-w","article-title":"The role of co-infections and secondary infections in patients with COVID-19","volume":"13","author":"Feldman","year":"2021","journal-title":"Pneumonia"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kol\u00e1\u0159, M., Rejman, D., and Bardo\u0148, J. (2020). Z\u00e1sady Antibiotick\u00e9 L\u00e9\u010dby [Principles of Antibiotic Treatment], Palack\u00fd University Olomouc.","DOI":"10.5507\/lf.20.24457406"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/s15010-021-01661-2","article-title":"Bacterial infections in critically ill patients with SARS-2-COVID-19 infection: Results of a prospective observational multicenter study","volume":"50","author":"Corona","year":"2022","journal-title":"Infection"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.cmi.2020.07.016","article-title":"Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis","volume":"26","author":"Langford","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.cmi.2020.07.041","article-title":"Incidence of co-infections and superinfections in hospitalized patients with COVID-19: A retrospective cohort study","volume":"27","author":"Sanjuan","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/j.cmi.2020.06.025","article-title":"Bacterial and fungal coinfection among hospitalized patients with COVID-19: A retrospective cohort study in a UK secondary-care setting","volume":"26","author":"Hughes","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"104364","DOI":"10.1016\/j.jcv.2020.104364","article-title":"Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan, China","volume":"127","author":"Zhang","year":"2020","journal-title":"J. Clin. Virol."},{"key":"ref_24","first-page":"359","article-title":"Bacterial coinfections in COVID-19: An underestimated adversary","volume":"56","author":"Fattorini","year":"2020","journal-title":"Ann. Dell\u2019Istituto Super. Sanita"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"304","DOI":"10.7326\/M20-2189","article-title":"Treatment of Community-Acquired Pneumonia During the Coronavirus Disease 2019 (COVID-19) Pandemic","volume":"173","author":"Metlay","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s15010-020-01553-x","article-title":"Bacterial coinfection in critically ill COVID-19 patients with severe pneumonia","volume":"49","author":"Elabbadi","year":"2021","journal-title":"Infection"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.jinf.2020.05.046","article-title":"Co-infections in people with COVID-19: A systematic review and meta-analysis","volume":"81","author":"Lansbury","year":"2020","journal-title":"J. Infect."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1186\/s13054-020-03135-7","article-title":"Co-infections in COVID-19 critically ill and antibiotic management: A prospective cohort analysis","volume":"24","author":"Verroken","year":"2020","journal-title":"Crit. Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e55","DOI":"10.1016\/j.jinf.2020.06.056","article-title":"Improving antibiotic stewardship in COVID-19: Bacterial co-infection is less common than with influenza","volume":"81","author":"Youngs","year":"2020","journal-title":"J. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1093\/cid\/ciaa524","article-title":"Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect?","volume":"71","author":"Clancy","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1079721","DOI":"10.3389\/fmed.2023.1079721","article-title":"Incidence and clinical outcomes of bacterial superinfections in critically ill patients with COVID-19","volume":"10","author":"Yoon","year":"2023","journal-title":"Front. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e28892","DOI":"10.1002\/jmv.28892","article-title":"Bacterial and fungal superinfections are detected at higher frequency in critically ill patients affected by SARS CoV-2 infection than negative patients and are associated to a worse outcome","volume":"95","author":"Signorini","year":"2023","journal-title":"J. Med. Virol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106409","DOI":"10.1016\/j.ijantimicag.2021.106409","article-title":"Antimicrobial stewardship in the ICU in COVID-19 times: The known unknowns","volume":"58","author":"Schouten","year":"2021","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e170682","DOI":"10.1172\/JCI170682","article-title":"Machine Learning Links Unresolving Secondary Pneumonia to Mortality in Patients with Severe Pneumonia, Including COVID-19","volume":"133","author":"Gao","year":"2023","journal-title":"J. Clin. Investig."},{"key":"ref_35","first-page":"2459","article-title":"Bacterial and Fungal Coinfection in Individuals with Coronavirus: A Rapid Review to Support COVID-19 Antimicrobial Prescribing","volume":"71","author":"Rawson","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.jmii.2022.09.006","article-title":"Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: Incidence, diagnosis and treatment","volume":"55","author":"Wu","year":"2022","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"ofac043","DOI":"10.1093\/ofid\/ofac043","article-title":"Community-Acquired Pneumonia in Canada During Coronavirus Disease 2019","volume":"9","author":"Mandell","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1700582","DOI":"10.1183\/13993003.00582-2017","article-title":"International ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)\/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociaci\u00f3n Latinoamericana del T\u00f3rax (ALAT)","volume":"50","author":"Torres","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_39","unstructured":"Heneghan, C., Pludermann, A., and Mahtani, K. (2023, October 14). Differentiating Viral from Bacterial Pneumonia. Available online: https:\/\/www.cebm.net\/covid-19\/differentiating-viral-from-bacterial-pneumonia."},{"key":"ref_40","unstructured":"(2023, June 22). COVID-19 Rapid Guideline: Managing: Managing COVID-19. Available online: https:\/\/www.nice.org.uk\/guidance\/ng191."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1067\/j.cpradiol.2021.09.009","article-title":"Imaging of Pulmonary Superinfections and Co-Infections in COVID-19","volume":"51","author":"Naranje","year":"2022","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"6485","DOI":"10.1007\/s00330-020-07018-x","article-title":"Comparison of the computed tomography findings in COVID-19 and other viral pneumonia in immunocompetent adults: A systematic review and meta-analysis","volume":"30","author":"Altmayer","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"E289","DOI":"10.1148\/radiol.2020202504","article-title":"Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era","volume":"297","author":"Parekh","year":"2020","journal-title":"Radiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13244-020-00933-z","article-title":"COVID-19 pneumonia: The great radiological mimicker","volume":"11","author":"Duzgun","year":"2020","journal-title":"Insights Imaging"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.ijid.2020.05.055","article-title":"Association of inflammatory markers with the severity of COVID-19: A meta-analysis","volume":"96","author":"Zeng","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"720363","DOI":"10.3389\/fimmu.2021.720363","article-title":"Update Advances on C-Reactive Protein in COVID-19 and Other Viral Infections","volume":"12","author":"Luan","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1016\/j.jiph.2023.06.018","article-title":"Inflammatory markers and COVID-19 disease progression","volume":"16","author":"Sidhwani","year":"2023","journal-title":"J. Infect. Public Health"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"j2471","DOI":"10.1136\/bmj.j2471","article-title":"Advances in the causes and management of community acquired pneumonia in adults","volume":"358","author":"Wunderink","year":"2017","journal-title":"BMJ"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1093\/cid\/ciz545","article-title":"Procalcitonin to Distinguish Viral from Bacterial Pneumonia: A Systematic Review and Meta-Analysis","volume":"70","author":"Kamat","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1159\/000533725","article-title":"An Unexpected Cause of Raised Procalcitonin","volume":"6","author":"Sabahat","year":"2023","journal-title":"Dubai Med. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1007\/s00134-011-2189-1","article-title":"Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study","volume":"37","author":"Cuquemelle","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"R44","DOI":"10.1186\/cc13760","article-title":"Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: A prospective cohort study, systematic review and individual patient data meta-analysis","volume":"18","author":"Pfister","year":"2014","journal-title":"Crit. Care"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s15010-021-01615-8","article-title":"C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19","volume":"49","author":"Pink","year":"2021","journal-title":"Infection"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e02167-20","DOI":"10.1128\/AAC.02167-20","article-title":"Limited Utility of Procalcitonin in Identifying Community-Associated Bacterial Infections in Patients Presenting with Coronavirus Disease 2019","volume":"65","author":"May","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Harte, E., Kumarasamysarma, S., Phillips, B., Mackay, O., Rashid, Z., Malikova, N., Mukit, A., Ramachandran, S., Biju, A., and Brown, K. (2023). Procalcitonin Values Fail to Track the Presence of Secondary Bacterial Infections in COVID-19 Icu Patients. Antibiotics, 12.","DOI":"10.3390\/antibiotics12040709"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1186\/s13054-020-03291-w","article-title":"Biomarkers for antimicrobial stewardship: A reappraisal in COVID-19 times?","volume":"24","author":"Kox","year":"2020","journal-title":"Crit. Care"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1080\/0036554021000026967","article-title":"Limited value of routine microbiological diagnostics in patients hospitalized for community-acquired pneumonia","volume":"34","author":"Lidman","year":"2002","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1080\/22221751.2020.1729071","article-title":"Molecular and serological investigation of 2019-nCoV infected patients: Implication of multiple shedding routes","volume":"9","author":"Zhang","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_59","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2023, July 12). Breakpoint Tables for Interpretation of MICs and Zone Diameters. Available online: http:\/\/www.eucast.org\/clinical_breakpoints."},{"key":"ref_60","first-page":"BR147","article-title":"Phenotypic detection of broad-spectrum beta-lactamases in microbiological practice","volume":"17","author":"Hanulik","year":"2011","journal-title":"Med. Sci. Monit."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e01140-18","DOI":"10.1128\/JCM.01140-18","article-title":"Phenotypic Detection of Carbapenemase-Producing Organisms from Clinical Isolates","volume":"56","author":"Tamma","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/jac\/dkp498","article-title":"Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae","volume":"65","author":"Dallenne","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Mlynarcik, P., Dolejska, M., Vagnerova, I., Kutilov\u00e1, I., and Kolar, M. (2021). Detection of clinically important \u03b2-lactamases by using PCR. FEMS Microbiol. Lett., 368.","DOI":"10.1093\/femsle\/fnab068"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2153","DOI":"10.1128\/JCM.40.6.2153-2162.2002","article-title":"Detection of plasmid-mediated AmpC beta-lactamase genes in clinical isolates by using multiplex PCR","volume":"40","author":"Hanson","year":"2002","journal-title":"J. Clin. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1128\/AAC.46.7.2155-2161.2002","article-title":"Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus","volume":"46","author":"Oliveira","year":"2002","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1128\/jcm.33.1.24-27.1995","article-title":"Detection of glycopeptide resistance genotypes and identification to the species level of clinically relevant enterococci by PCR","volume":"33","author":"Evers","year":"1995","journal-title":"J. Clin. Microbiol."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Schoettler, J.J., Sandrio, S., Boesing, C., Bauer, L., Miethke, T., Thiel, M., and Krebs, J. (2023). Bacterial Co- or Superinfection in Patients Treated in Intensive Care Unit with COVID-19- and Influenza-Associated Pneumonia. Pathogens, 12.","DOI":"10.3390\/pathogens12070927"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e533","DOI":"10.1093\/cid\/ciaa1239","article-title":"Empiric Antibacterial Therapy and Community-onset Bacterial Coinfection in Patients Hospitalized with Coronavirus Disease 2019 (COVID-19): A Multi-hospital Cohort Study","volume":"72","author":"Vaughn","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"100054","DOI":"10.1016\/j.jcvp.2021.100054","article-title":"Nosocomial infections amongst critically ill COVID-19 patients in Australia","volume":"4","author":"Ramanan","year":"2021","journal-title":"J. Clin. Virol. Plus"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Bussolati, E., Cultrera, R., Quaranta, A., Cricca, V., Marangoni, E., La Rosa, R., Bertacchini, S., Bellonzi, A., Ragazzi, R., and Volta, C.A. (2022). Effect of the Pandemic Outbreak on ICU-Associated Infections and Antibiotic Prescription Trends in Non-COVID19 Acute Respiratory Failure Patients. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237080"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Oliva, J., and Terrier, O. (2021). Viral and Bacterial Co-Infections in The Lungs: Dangerous Liaisons. Viruses, 13.","DOI":"10.3390\/v13091725"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Bogdanov\u00e1, K., Doubravsk\u00e1, L., V\u00e1gnerov\u00e1, I., Hricov\u00e1, K., Pudov\u00e1, V., R\u00f6derov\u00e1, M., Papajk, J., Uv\u00edzl, R., Langov\u00e1, K., and Kol\u00e1\u0159, M. (2021). Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia. Life, 11.","DOI":"10.3390\/life11111127"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Doubravsk\u00e1, L., Htoutou Sedl\u00e1kov\u00e1, M., Fi\u0161erov\u00e1, K., Pudov\u00e1, V., Urb\u00e1nek, K., Petr\u017eelov\u00e1, J., R\u00f6derov\u00e1, M., Langov\u00e1, K., Mezerov\u00e1, K., and Ku\u010dov\u00e1, P. (2022). Bacterial Resistance to Antibiotics and Clonal Spread in COVID-19-Positive Patients on a Tertiary Hospital Intensive Care Unit, Czech Republic. Antibiotics, 11.","DOI":"10.3390\/antibiotics11060783"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.ajic.2007.05.007","article-title":"Airflow and droplet spreading around oxygen masks: A simulation model for infection control research","volume":"35","author":"Ip","year":"2007","journal-title":"Am. J. Infect. Control"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.jhin.2018.10.007","article-title":"Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: A randomized controlled crossover trial","volume":"101","author":"Leung","year":"2019","journal-title":"J. Hosp. Infect."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.jhin.2019.11.010","article-title":"Assessment of the potential for pathogen dispersal during high-flow nasal therapy","volume":"104","author":"Kotoda","year":"2020","journal-title":"J. Hosp. Infect."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2000892","DOI":"10.1183\/13993003.00892-2020","article-title":"High-flow nasal cannula for COVID-19 patients: Low risk of bio-aerosol dispersion","volume":"55","author":"Li","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2003004","DOI":"10.1183\/13993003.03004-2020","article-title":"High-flow nasal cannula for COVID-19 patients: Risk of bio-aerosol dispersion","volume":"56","author":"Elshof","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/0897190021998502","article-title":"A Review of the Evidence for Corticosteroids in COVID-19","volume":"35","author":"Johns","year":"2022","journal-title":"J. Pharm. Pract."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s11739-021-02824-7","article-title":"Bacterial Infections in Patients Hospitalized with COVID-19","volume":"17","author":"Callejas","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1164\/rccm.202105-1302OC","article-title":"Latent Class Analysis Reveals COVID-19\u2013Related Acute Respiratory Distress Syndrome Subgroups with Differential Responses to Corticosteroids","volume":"204","author":"Sinha","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/anae.15425","article-title":"Mortality in patients admitted to intensive care with COVID-19: An updated systematic review and meta-analysis of observational studies","volume":"76","author":"Armstrong","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Musuuza, J.S., Watson, L., Parmasad, V., Putman-Buehler, N., Christensen, L., and Safdar, N. (2021). Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251170"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Iacovelli, A., Oliva, A., Siccardi, G., Tramontano, A., Pellegrino, D., Mastroianni, C.M., Venditti, M., and Palange, P. (2023). Risk Factors and Effect on Mortality of Superinfections in A Newly Established COVID-19 Respiratory Sub-Intensive Care Unit at University Hospital in Rome. BMC Pulm. Med., 23.","DOI":"10.1186\/s12890-023-02315-9"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1016\/j.jiph.2021.06.012","article-title":"Outcomes and Risk Factors for Death in Patients with Coronavirus Disease-2019 (COVID-19) Pneumonia Admitted to The Intensive Care Units of An Egyptian University Hospital. A Retrospective Cohort Study","volume":"14","author":"Nassar","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1164\/rccm.202106-1354OC","article-title":"Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated For COVID-19 Pneumonia","volume":"204","author":"Pickens","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.jinf.2020.03.019","article-title":"Coronavirus Disease 2019 in Elderly Patients: Characteristics and Prognostic Factors Based On 4-Week Follow-Up","volume":"80","author":"Wang","year":"2020","journal-title":"J. Infect."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.redar.2020.07.003","article-title":"Caracter\u00edsticas, Evoluci\u00f3n Cl\u00ednica Y Patient characteristics, clinical course and factors associat-ed to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: A prospective, cohort, multicentre study. Rev Esp Anestesiol Reanim (Engl Ed)","volume":"67","author":"Ferrando","year":"2020","journal-title":"Rev. Espa\u00f1ola Anestesiol. Reanim."},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Michailides, C., Paraskevas, T., Karalis, I., Koniari, I., Pierrakos, C., Karamouzos, V., Marangos, M., and Velissaris, D. (2023). Impact of Bacterial Infections On COVID-19 Patients: Is Timing Important?. Antibiotics, 12.","DOI":"10.3390\/antibiotics12020379"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1177\/00045632211022380","article-title":"Elevated Procalcitonin Concentrations in Severe COVID-19 May Not Reflect Bacterial Co-Infection","volume":"58","author":"Heer","year":"2021","journal-title":"Ann. Clin. Bio-Chem. Int. J. Lab. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1080\/17843286.2020.1824749","article-title":"Procalcitonin and Secondary Bacterial Infections in Covid-19: Association with Disease Severity and Outcomes","volume":"77","author":"Vazzana","year":"2022","journal-title":"Acta Clin. Belg."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/S2213-2600(21)00218-6","article-title":"The COVID-19 Puzzle: Deciphering Pathophysiology and Phenotypes of a New Disease Entity","volume":"9","author":"Osuchowski","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_93","first-page":"e39604","article-title":"Prevalence of Hospital-Acquired Pneumonia Among Patients with Severe to Critical COVID-19 Pneumonia Given Tocilizumab","volume":"15","author":"Adre","year":"2023","journal-title":"Cureus"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"104370","DOI":"10.1016\/j.jcv.2020.104370","article-title":"Prognostic Value of Interleukin-6, C-Reactive Protein, And Procalcitonin in Patients with COVID-19","volume":"127","author":"Liu","year":"2020","journal-title":"J. Clin. Virol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jinf.2020.12.001","article-title":"High rate of infections during ICU admission of patients with severe SARS-CoV-2 pneumonia: A matter of time?","volume":"82","author":"Barrasa","year":"2021","journal-title":"J. Infect."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"198005","DOI":"10.1016\/j.virusres.2020.198005","article-title":"Co-infection with respiratory pathogens among COVID-19 cases","volume":"285","author":"Zhu","year":"2020","journal-title":"Virus Res."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s13613-020-00736-x","article-title":"Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU","volume":"10","author":"Contou","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"448","DOI":"10.5507\/bp.2016.014","article-title":"Epidemiology of hospital-acquired pneumonia: Results of a Central European multicenter, prospective, observational study compared with data from the European region","volume":"160","author":"Herkel","year":"2016","journal-title":"Biomed. Pap."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/2\/192\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:00:53Z","timestamp":1760104853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/2\/192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,16]]},"references-count":98,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["antibiotics13020192"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13020192","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,16]]}}}