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Aetiology and impact of bacterial bloodstream infections in mechanically ventilated COVID-19 patients : A prospective Swedish multicenter cohort study

Olsson, Isak LU ; Nilsson, Anna C. LU ; Didriksson, Ingrid LU orcid ; Frigyesi, Attila LU ; Friberg, Hans LU ; Reepalu, Anton LU orcid and Spångfors, Martin LU orcid (2026) In PLOS ONE 21(1 January).
Abstract

Objectives Critically ill COVID-19 patients admitted to the intensive care unit (ICU) are at an increased risk of acquiring bacterial bloodstream infections (BSI). We aimed to describe patient characteristics, risk factors, and the microbiological spectrum in blood cultures and evaluate the impact of ICU-acquired BSI on outcomes in a Nordic setting. Methods A prospective multicenter cohort study was conducted on adult invasively mechanically ventilated (IMV) COVID-19 patients. The primary aim was to identify the proportion of ICU-acquired BSI and its aetiology. Secondary outcomes were duration of IMV, length of stay (LOS), and mortality for individuals with and without BSI, respectively. Logistic regression was used to identify... (More)

Objectives Critically ill COVID-19 patients admitted to the intensive care unit (ICU) are at an increased risk of acquiring bacterial bloodstream infections (BSI). We aimed to describe patient characteristics, risk factors, and the microbiological spectrum in blood cultures and evaluate the impact of ICU-acquired BSI on outcomes in a Nordic setting. Methods A prospective multicenter cohort study was conducted on adult invasively mechanically ventilated (IMV) COVID-19 patients. The primary aim was to identify the proportion of ICU-acquired BSI and its aetiology. Secondary outcomes were duration of IMV, length of stay (LOS), and mortality for individuals with and without BSI, respectively. Logistic regression was used to identify potential predictors of ICU-acquired BSI. Predictors were assessed by calculating an Area Under the Receiver Operating Characteristics (AUROC) curve. Results Of 354 included patients, 17% had an ICU-acquired BSI. Staphylococcus aureus was the most common pathogen. Patients with BSI had a longer duration of IMV (20 days versus 9 days, p<0.001), longer ICU-LOS (24 days versus 11 days, p<0.001), and hospital-LOS (38 days versus 24 days, p<0.001). A BSI was associated with increased mortality; odds ratio (OR) 3.21, 95% CI: 1.61–6.38, p<0.001. Adjusted analyses showed that higher BMI; OR 1.06, 95% CI: 1.01–1.11, p=0.014, diabetes mellitus with organ complications; OR 2.66, 95% CI: 1.33–5.29, p=0.005, and number of symptomatic days before ICU admission; OR 1.04, 95% CI: 1.01–1.07, p=0.008, were associated with a BSI. The AUROC was 0.66 (95% CI: 0.58–0.74). Conclusion ICU-acquired BSIs were found in 17% of critically ill COVID-19 patients and were associated with a longer duration of IMV and LOS as well as increased mortality. Staphylococcus aureus was the dominating pathogen. We found several factors associated with ICU-acquired BSIs at ICU admission. However, their ability to predict BSIs was poor.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLOS ONE
volume
21
issue
1 January
article number
e0340476
publisher
Public Library of Science (PLoS)
external identifiers
  • scopus:105026840450
  • pmid:41494027
ISSN
1932-6203
DOI
10.1371/journal.pone.0340476
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 Olsson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
id
fad19ef1-e918-4dc8-ab62-373c2e738c63
date added to LUP
2026-03-19 14:55:27
date last changed
2026-04-16 17:51:25
@article{fad19ef1-e918-4dc8-ab62-373c2e738c63,
  abstract     = {{<p>Objectives Critically ill COVID-19 patients admitted to the intensive care unit (ICU) are at an increased risk of acquiring bacterial bloodstream infections (BSI). We aimed to describe patient characteristics, risk factors, and the microbiological spectrum in blood cultures and evaluate the impact of ICU-acquired BSI on outcomes in a Nordic setting. Methods A prospective multicenter cohort study was conducted on adult invasively mechanically ventilated (IMV) COVID-19 patients. The primary aim was to identify the proportion of ICU-acquired BSI and its aetiology. Secondary outcomes were duration of IMV, length of stay (LOS), and mortality for individuals with and without BSI, respectively. Logistic regression was used to identify potential predictors of ICU-acquired BSI. Predictors were assessed by calculating an Area Under the Receiver Operating Characteristics (AUROC) curve. Results Of 354 included patients, 17% had an ICU-acquired BSI. Staphylococcus aureus was the most common pathogen. Patients with BSI had a longer duration of IMV (20 days versus 9 days, p&lt;0.001), longer ICU-LOS (24 days versus 11 days, p&lt;0.001), and hospital-LOS (38 days versus 24 days, p&lt;0.001). A BSI was associated with increased mortality; odds ratio (OR) 3.21, 95% CI: 1.61–6.38, p&lt;0.001. Adjusted analyses showed that higher BMI; OR 1.06, 95% CI: 1.01–1.11, p=0.014, diabetes mellitus with organ complications; OR 2.66, 95% CI: 1.33–5.29, p=0.005, and number of symptomatic days before ICU admission; OR 1.04, 95% CI: 1.01–1.07, p=0.008, were associated with a BSI. The AUROC was 0.66 (95% CI: 0.58–0.74). Conclusion ICU-acquired BSIs were found in 17% of critically ill COVID-19 patients and were associated with a longer duration of IMV and LOS as well as increased mortality. Staphylococcus aureus was the dominating pathogen. We found several factors associated with ICU-acquired BSIs at ICU admission. However, their ability to predict BSIs was poor.</p>}},
  author       = {{Olsson, Isak and Nilsson, Anna C. and Didriksson, Ingrid and Frigyesi, Attila and Friberg, Hans and Reepalu, Anton and Spångfors, Martin}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{1 January}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLOS ONE}},
  title        = {{Aetiology and impact of bacterial bloodstream infections in mechanically ventilated COVID-19 patients : A prospective Swedish multicenter cohort study}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0340476}},
  doi          = {{10.1371/journal.pone.0340476}},
  volume       = {{21}},
  year         = {{2026}},
}