Abstract
Purpose
Coronavirus disease 2019 (COVID-19) increases the risk of bloodstream infections (BSI), but associated risk factors remain incompletely characterized. We aimed to evaluate BSI risk factors in patients admitted to the intensive care unit for COVID-19.Materials and methods
This nationwide multicenter study, conducted across 22 university-affiliated hospitals in South Korea, included COVID-19 patients treated with high-flow nasal cannula (HFNC) therapy or mechanical ventilation. Baseline characteristics were compared between patients who developed BSI within 30 days and those who did not. Pathogens were analyzed, risk factors were evaluated using multivariable logistic regression, and supplementary Cox proportional hazards analyses were performed to address time-dependent outcomes.Results
Of 573 included patients, 206 (35.9%) developed at least one BSI episode. Staphylococcus species were the most frequent isolates. Gram-negative bacteria became increasingly prevalent over time, while fungal infections were associated with prolonged hospitalization. Multivariable analysis identified chronic neurological disease, higher baseline Sequential Organ Failure Assessment score, mechanical ventilation, prone positioning, and extracorporeal membrane oxygenation (ECMO) use prior to infection as independent BSI predictors. Notably, although crude in-hospital mortality was significantly higher in the BSI group (41.5% vs. 31.7%, p=0.012), BSI was not an independent predictor of in-hospital mortality in either logistic regression or Cox analyses.Conclusion
In critically ill patients with COVID-19, high baseline severity, chronic neurological disease, and pre-infection advanced life support (mechanical ventilation and ECMO) were independent predictors of BSI. Rather than acting as an independent cause of death, BSI primarily serves as a clinical marker of extreme illness severity and prolonged invasive interventions.