Nicolas massart trial

For the first variable, we assume that patients needing renal replacement therapy have a high probability of early death, competing with BSI occurrence. Similarly, use of epinephrine was not associated with an increased risk of BSI.

For the second one, it suggests that patients have a higher risk of BSI soon after admission, while facing a more severe condition, whereas this risk decreases over time, with clinical improvement.

Caregivers should be careful about BSI early after admission. Interestingly, corticosteroids use was not associated with increased risk of BSI. In a recent multicenter observational study, use of dexamethasone was not associated with an increased risk of BSI [ 23 ].

Similar results were found in another case—control study [ 11 ]. Data regarding immunomodulatory drug use and risk of BSI are discordant in ICU patients: a recent randomized placebo-controlled trial found no increased risk of infection with tocilizumab use [ 24 ].

Abelenda-Alonso et al. In our study, although few patients received tocilizumab, its use was not associated with an increased risk of BSI.

However, those experiencing BSI after tocilizumab use had an increased mortality as compared with BSI patients who did not received this agent. Combined with the lack of effect of anti-IL6 drugs in the most severe patients, their use should be cautiously outweighed in ICU patients.

Similarly, BSI patients with previous antibiotic exposure had an increased risk of death. We hypothesized that antibiotic pressure selected resistant microorganisms in which empiric therapy was more likely to fail. Several limitations of our study should be underlined. First, some data are missing, which is inherent to this kind of multicenter observational study [ 13 ].

Other relevant missing values were date of BSI occurrence after day 21 for 40 patients, BSI occurred after day 21 but without additional precision , susceptibility of pathogen responsible for infection wild type, multi-drug resistant… appropriateness and duration of antimicrobial treatment.

Second, this study was performed during the first wave, between March and May Since care of COVID ICU patients has changed with improvement over time, and differ from one country to another, results might be different in different countries and among different waves of the pandemic. In particular, with the widespread use of corticosteroids and the increased use of anti-IL-6 drugs, incidence of BSI and outcomes may be different.

Third, we defined BSI as a single positive blood culture. For some pathogens such as Staphylococcus epidermidis , 2 blood cultures taken apart are required to define BSI. We, therefore, might have overestimated the rate of BSI. However, the rate of BSI in our study was similar to other reports [ 3 , 11 ] and lower than other [ 9 ].

Moreover, other studies found a high rate of BSI due to Staphylococcus epidermidis [ 12 ]. In our study, BSI patients infected with unknown pathogen and those infected with an identified micro-organism had similar outcomes, and should be both similarly considered. However, this bias would lead to underestimation of mortality risk associated with BSI, since patients experiencing this event are those surviving longer enough, whereas those who died early have short time of exposition but were even included in control group.

In conclusion, BSI is a frequent complication of critically ill COVID patients, especially early after ICU admission and is associated with increased severity at admission but not with corticosteroids use. NM and PF performed statistical analysis. All authors made significant intellectual concept.

All authors read and approved the final manuscript. The funder had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

The other authors have no conflicts of interest to declare in relationship to this manuscript. Publisher's Note. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Nicolas Massart and Virginie Maxime contributed equally and should be both considered as first authors. Fabrice Bruneel and Charles-Edouard Luyt contributed equally and should be both considered as senior authors. Change history. A Correction to this paper has been published: National Center for Biotechnology Information , U.

Journal List Ann Intensive Care v. Ann Intensive Care. Published online Dec Author information Article notes Copyright and License information Disclaimer. Charles-Edouard Luyt, Email: rf. Corresponding author. Received Sep 28; Accepted Dec The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.

If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

This article has been corrected. See Ann Intensive Care. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Additional file 1. Supplementary results. Abstract Background Patients infected with the severe acute respiratory syndrome coronavirus 2 SARS-COV 2 and requiring intensive care unit ICU have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections BSI are scarce.

Results Among included patients, Supplementary Information The online version contains supplementary material available at Background As a consequence of severe acute respiratory syndrome coronavirus-2 SARS-COV 2 epidemic, intensive care units ICU worldwide faced a surge of critically ill patients who are at risk of developing bacterial infections, in particular patients requiring mechanical ventilation MV [ 1 — 3 ].

Statistical analysis Statistical analysis was performed with the statistical software R 3. Open in a separate window. Table 1 Baseline characteristics of patients according to their status, namely, bloodstream infection or not. Table 2 Risk factors for bloodstream infection, using a Fine and Gray competing risk analysis. Table 3 Risk factors for death for the whole population. Table 4 Outcomes among patients with bloodstream infection and their propensity-matched patients without bloodstream infection.

Supplementary Information Additional file 1. Availability of data and materials The data sets generated during the current study are available from the corresponding author on reasonable request.

Declarations Ethics approval and consent to participate Human research ethics committee approval for the study was the ethical committee of the French Intensive Care Society CE-SRLF following our local regulations. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study.

Intensive Care Med. Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease. Crit Care. Clinical characteristics of Covid in New York City. N Engl J Med.

Bacterial and fungal coinfection among hospitalized patients with COVID a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect. J Clin Microbiol. Predominance of hospital-acquired bloodstream infection in patients with Covid pneumonia. Infect Dis. Eur J Clin Invest. Community-acquired and hospital-acquired respiratory tract infection and bloodstream infection in patients hospitalized with COVID pneumonia.

J Intensive Care. Risk factors and outcomes of hospitalized patients with severe Coronavirus Disease COVID and secondary bloodstream infections: a multicenter case-control study. And a bigger vid is coming with big side hops This amazing guy can climb height pallets banging the front wheel and This is not a joke Nicolas Massart street riding. This interview is in French sorr On en parle sur msn prochainement! Il faut que je regarde comment cela fonctionne techniquement! Normalement le site permet de faire du multilinguisme assez facilement En attendant j'ai mis un gadget de traduction Google Nicely controled ridding , very chilled out.

I realy enjoyed that video for 17yrs he is TOP looking forward for the bigger video! The song was a big time mistake. Though riding was of course good. Really good rider, especially for You can post now and register later.

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