Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

Purpose: To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods: Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results: 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions: ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Heteragrion beschkii Hagen 1862

<i>Heteragrion beschkii</i> Hagen in Selys, 1862 <p>(Figs. 15a–d)</p> <p>[Key locator: Key to Group A species, couplet 16 (15)]</p> <p> <i>Heteragrion beschkii</i>: Hagen in Selys 1862: 27–28 [25–26 reprint] (description and diagnosis of ♁ from Nova Friburgo, Brazil; comparison with <i>H. aurantiacum</i> and <i>H. consors</i>);— Selys 1886: 59 (species diagnosis);— Williamson 1919: 26 (key to species, ♁ in couplet d2; brief species diagnosis and illustration of ♁ head, appendages in mediodorsal and lateral views and prothorax; figs. 20, 82–83, 139);— Costa & Santos 2000: 4 (identification key);— Lencioni 2005: 128 (description and distribution, illustration of misidentified specimen);—Machado 2006: 1065 (comparison with <i>H. gracile</i>);— Garrison <i>et al.</i> 2010: 88 (list of <i>Heteragrion</i> species);— Lencioni 2013: 7 (synonymic list, type deposit, distribution, diagnosis; figs. 12, 32a–c, 32d, 73);—Ávila-Jr. <i>et al.</i> 2017: 284–285 (comparison with <i>H. cauei</i>);— Lencioni 2017: 131–132 (general taxonomic information; distribution; figs. 58–59).</p> <p> <b>Material examined.</b> Known only from type material; examined through original description and lectotype images (type housed at MCZ).</p> <p> <b>Known distribution.</b> Brazil (Nova Friburgo, Rio de Janeiro state).</p> <p> <b>Diagnosis and remarks.</b> This poorly known species can be separated from the remainder of Group A species by the following character combination: BP slightly hollow, densely hairy (Fig. 15c); ML ridge bearing strong teeth, reaching its apex (Fig. 15c); in lateral view, BP with a dorsobasal expansion (Fig. 15d); ML apex squared (Fig. 15c). The current conservation status of this species is uncertain, as it has only been recorded from a small number of specimens, with the most recent collection dating back over 30 years (Vilela & Guillermo-Ferreira 2021a). Therefore, further collections are needed to assess its present conservation status. The IUCN Red List has assigned it a Data Deficient (DD) status (Vilela & Guillermo-Ferreira 2021a).</p>Published as part of <i>Vilela, Diogo Silva, Lencioni, Frederico A. A., Bota-Sierra, Cornelio A., Ware, Jessica L. & Bispo, Pitágoras C., 2023, Taxonomic revision of the Neotropical genus Heteragrion Selys, 1862 (Zygoptera: Heteragrionidae): male morphology, new species and illustrated key, pp. 1-96 in Zootaxa 5356 (1)</i> on page 28, DOI: 10.11646/zootaxa.5356.1.1, <a href="http://zenodo.org/record/10008529">http://zenodo.org/record/10008529</a&gt

Heteragrion cooki : Daigle & Tennessen 2000

<i>Heteragrion cooki</i> Daigle & Tennessen, 2000 <p>(Figs. 26a–d)</p> <p>[Key locator: Key to Group A species, couplet 8’]</p> <p> <i>Heteragrion cooki</i>: Daigle & Tennessen 2000: 255–259 (description of ♁ and ♀; diagnosis and comparison with <i>H. alienum</i> and <i>H. aurantiacum</i>; figs. 1–10);— De Marmels 2004: 447 (comparison with <i>H. makiritare</i> and other <i>Heteragrion</i> species; figs. 18–19);— Tennessen & Johnson 2008: 9–11 (list of species from southern Ecuador);— Garrison <i>et al.</i> 2010: 88, 91 (list of <i>Heteragrion</i> species; figs. 387–388);— Rivas-Torres <i>et al.</i> 2017: 123–135 (demographics and behavioral ecology);— Medina-Espinoza 2022: 236–240 (first record to Peru).</p> <p> <b>Material examined.</b> 1♁ ECUADOR, El Oro Province, Piedras, 4.vii.1941, (-3.6333, -79.9166, 300m asl), D.B. Laddey leg., ABMM; 4♁♁ Bosque Seco Lalo Loor, 30.xi.2012, (-0.0834, -80.1485, 65m asl), A.C. Rivera leg., ECOEVO; 6♁♁ El Oro, Cantón Piñas, 18.vi.2016, (-3.6529, -79.7652, 532m asl), I. Sanmartín-Villar & A. Rivas-Torres leg., ECOEVO.</p> <p> <b>Known distribution.</b> Ecuador and Peru.</p> <p> <b>Diagnosis and remarks.</b> This species shares with <i>H. silvarum</i> and <i>H. cinnamomeum</i> the cercus with a long BP, ending in subequal MP and AP, with a developed ML. The following character combination distinguishes this species from the remainder of Group A species: BP the longest cercus portion, nearly straight (Figs. 26c–d); on the MP, ML broad, bearing an elevated ridge (Fig. 26c); ML apex with a small cleft (Fig. 26d).</p>Published as part of <i>Vilela, Diogo Silva, Lencioni, Frederico A. A., Bota-Sierra, Cornelio A., Ware, Jessica L. & Bispo, Pitágoras C., 2023, Taxonomic revision of the Neotropical genus Heteragrion Selys, 1862 (Zygoptera: Heteragrionidae): male morphology, new species and illustrated key, pp. 1-96 in Zootaxa 5356 (1)</i> on page 41, DOI: 10.11646/zootaxa.5356.1.1, <a href="http://zenodo.org/record/10008529">http://zenodo.org/record/10008529</a&gt

Heteragrion rubrifulvum : Donnelly 1992

<i>Heteragrion rubrifulvum</i> Donnelly, 1992 <p>(Figs. 59a–c)</p> <p>[Key locator: Key to Group B species, couplet 10’]</p> <p> <i>Heteragrion rubrifulvum</i>: Donnelly 1992: 55, 57–59 (key to species of <i>Heteragrion</i> from Central Panama, ♁ in couplet 2’; description and diagnosis of ♁; comparison with <i>H. erythrogastrum</i> and <i>H. albifrons</i>; 5.2, 5.12, 5.17);— Garrison <i>et al.</i> 2010: 88 (list of <i>Heteragrion</i> species);— Molinar <i>et al.</i> 2015: 87 (list of species from Panama).</p> <p> <b>Material examined.</b> Examined through original description and holotype images (holotype housed at MCZ).</p> <p> <b>Known distribution.</b> Central Panama.</p> <p> <b>Diagnosis and remarks.</b> This species is assessed as Data Deficient in the IUCN Red List, as it is a poorly known taxon, known from only the type locality, pending additional collections to determine its current conservation status (González-Soriano & Guzmán Ojeda 2021a). Donnelly (1992) stated that this species “stands quite alone in the genus for near absence of black markings”. The following character combination distinguishes this species from the remainder of Group B species: head red, remainder of body pale yellow; ridge above ML straight, its apex sclerotized (Fig. 59c); ML with acute apex (Fig. 59c); AP with a longitudinal depression (Fig. 59c).</p>Published as part of <i>Vilela, Diogo Silva, Lencioni, Frederico A. A., Bota-Sierra, Cornelio A., Ware, Jessica L. & Bispo, Pitágoras C., 2023, Taxonomic revision of the Neotropical genus Heteragrion Selys, 1862 (Zygoptera: Heteragrionidae): male morphology, new species and illustrated key, pp. 1-96 in Zootaxa 5356 (1)</i> on page 81, DOI: 10.11646/zootaxa.5356.1.1, <a href="http://zenodo.org/record/10008529">http://zenodo.org/record/10008529</a&gt

Heteragrion ochraceum Hagen 1862

<i>Heteragrion ochraceum</i> Hagen in Selys, 1862 <p> <i>Heteragrion ochraceum</i>: Selys 1862: 22–23 (description of ♁ and ♀ from Rio de Janeiro state; comparison of ♁ with <i>H. beschkii</i>; Selys states that he did not see the male and could not perform a good comparison with other species);— Williamson 1919: 24–25 (suggests synonymy with <i>H. cinnamomeum</i>, also similarities with <i>H. aurantiacum</i>; states that the tubercle mentioned by Selys in the ♀ head is absent);— Garrison <i>et al.</i> 2010: 88 (list of <i>Heteragrion</i> species);— Lencioni 2013: 4 (mentions taxonomic problems concerning this name).</p> <p> <b>Material examined.</b> None.</p> <p> <b>Known distribution.</b> Brazil (Nova Friburgo, Rio de Janeiro state).</p> <p> <b>Diagnosis and remarks.</b> Regarding <i>H. ochraceum</i>, it was described by Selys (1862) based on the two sexes, including one male and two females (one of them teneral). According to Williamson (1919), Hagen considered <i>H. cinnamomeum</i> to be a junior synonym of <i>H. ochraceum</i>, though not formalizing this proposition. Additionally, one can observe many similarities between the female assigned as <i>H. ochraceum</i> (depicted by Williamson 1919, Plate IV fig. 19) and the female assigned as <i>H. aurantiacum</i> (Lencioni 2013, fig. 50b). The main problem is that the type specimens are now incomplete (the male is missing) and impossible to associate with any valid name (von Ellenrieder & Garrison 2007). However, as we have not studied the types in person, for now we do not consider this name as <i>nomen dubium</i>. Currently, there is not enough taxonomic information on this species to formalize a proper diagnosis. See further discussion under <i>H. cinnamomeum</i>.</p>Published as part of <i>Vilela, Diogo Silva, Lencioni, Frederico A. A., Bota-Sierra, Cornelio A., Ware, Jessica L. & Bispo, Pitágoras C., 2023, Taxonomic revision of the Neotropical genus Heteragrion Selys, 1862 (Zygoptera: Heteragrionidae): male morphology, new species and illustrated key, pp. 1-96 in Zootaxa 5356 (1)</i> on page 71, DOI: 10.11646/zootaxa.5356.1.1, <a href="http://zenodo.org/record/10008529">http://zenodo.org/record/10008529</a&gt