Predictors and outcomes of healthcare-associated infections among patients with COVID-19 admitted to intensive care units in Punjab, Pakistan; findings and implications

Healthcare-associated infections (HAIs) have a considerable impact on morbidity, mortality and costs. The COVID-19 pandemic resulted in an appreciable number of hospitalized patients being admitted to intensive care units (ICUs) globally with a greater risk of HAIs. Consequently, a need to evaluate predictors and outcomes of HAIs among COVID-19 patients admitted to ICUs. A retrospective study of patients with COVID-19 admitted to the ICUs of three tertiary care hospi-tals in the Punjab province over a five-month period in 2021 was undertaken to ascertain pre-dictors and outcomes of HAIs. Of 4534 hospitalized COVID-19 patients, 678 were admitted to ICUs, of whom 636 patients fulfilled the inclusion criteria. Overall, 67 HAIs were identified among admitted patients. Ventilator-associated lower respiratory tract infections and catheter related urinary tract infections were the most frequent HAIs. A significantly higher number of patients who developed HAIs were on anticoagulants (p = 0.003), antithrombotic agents (p < 0.001), anti-virals (p < 0.001) and IL-6 inhibiting agents (p < 0.001). Secondary infections were significantly higher in patients who were on invasive mechanical ventilation (p < 0.001), had central venous access (p = 0.023), and urinary catheters (p < 0.001). The mortality rate was significantly higher in those with secondary infections (25.8% vs 1.2%, p < 0.001). Our study concluded that COVID-19 patients admitted to ICU have a high prevalence of HAIs associated with greater mortality. Key factors need to be addressed to reduce HAIs.