{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:04:24Z","timestamp":1787871864233,"version":"build-2784847793"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T00:00:00Z","timestamp":1749081600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>The objective of the study is to understand the prevalence of bacterial co-infection and secondary infection in severe coronavirus disease 2019 (COVID-19) pneumonia in a tertiary hospital intensive care unit (ICU), the spectrum of pathogens, and the impact of these infections on clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>Retrospective analysis of all patients with COVID-19 with acute hypoxemic respiratory failure who were admitted to the ICU requiring invasive mechanical ventilation (IMV) or high-flow nasal cannula (HFNC) from January 2021 to August 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 123 cases, 59.3% had culture-confirmed bacterial co-infection, mostly lower respiratory tract infections (LRTIs). Patients with bacterial co-infection had higher 30-day mortality (28.8% vs. 12%, hazard ratio [HR] = 2.96, %95 confidence interval [CI] =1.1\u20137.99; adjusted HR [aHR] = 1.34, %95 CI = 0.43\u20134.17).\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa<\/jats:italic>\n                      were the most common co-infection pathogens. Of the 108 cases who stayed in the ICU for &gt;2 days, 34 (31.5%) cases developed secondary bacterial infections within 30 days, of whom all cases had LRTI, 4 had bacteremia, and 8 had urinary tract infections. IMV users had a higher 1-month incidence of secondary bacterial infections than HFNC users (47.5% vs. 8.9%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001). Patients with secondary bacterial infections had higher 60-day mortality (32.4% vs. 11.2% HR = 3.45, 95% CI = 1.27\u20139.4; aHR = 2.29, %95 CI =0.8\u20136.67). The most common secondary infection pathogens were\n                      <jats:italic toggle=\"yes\">Acinetobacter<\/jats:italic>\n                      species,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      .\n                      <jats:italic toggle=\"yes\">aeruginosa, Stenotrophomonas maltophilia<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">K<\/jats:italic>\n                      .\n                      <jats:italic toggle=\"yes\">pneumoniae<\/jats:italic>\n                      . At the 30-day follow-up, 54 events of ICU-acquired secondary bacterial LRTI were noted in 34 patients, 18 (33.3%) events, and 15 (44%) patients were infected by carbapenem-resistant Gram-negative bacilli.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The high incidence of bacterial co-infection and secondary infection in critically ill patients with COVID-19 might associated with increased mortality. Infection by drug-resistant pathogens may develop during the treatment course.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/tcmj.tcmj_255_24","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T17:00:10Z","timestamp":1749142810000},"page":"304-310","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Bacterial co-infection and secondary infection in critically ill patients with acute respiratory failure of coronavirus disease 2019"],"prefix":"10.4103","volume":"37","author":[{"given":"Yi-Ting","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien, 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