Mortality and its etiological factors in a COVID-19 intensive care unit in Tunisia

Introduction: High death rates were recorded during the COVID-19 pandemic with a major negative impact worldwide. Objectives: We aimed at determining etiological factors of mortality among COVID-19 patients admitted in intensive care unit in the region of Mahdia (Tunisia). Methods: We performed a cross sectional study between October 2020 and February 2021 among all patients admitted in the COVID-19 intensive care unit of the University Hospital Taher Sfar Mahdia. We collected data about nosocomial infection, characteristics of etiological bacterial and fungal species and death. Results: A total of 95 patients admitted in the COVID intensive care unit were enrolled with a mean age of 60.6 ± 13.5 years. Regarding the stay duration, we recorded a median of 16 days (IQR 9-25). About 67.4% of participants had nosocomial infection with 49 patients had at least 2 different episodes of infection. The most common infection types were urinary tract infection (50/152), ventilator-associated pneumonia (44/152) and bacteremia (44/152). About 55.7% of isolated bacteria were multi-resistant to antibiotics. The overall mortality was 53.7%. It was associated significantly with a higher mean age (54.2 ± 11.5 vs 40.8 ± 12.9, OR 2, CI 95% 1.5-4.8;p = 0.02), nosocomial infection (OR 5, CI 95% 2.2-15;p < 0.001) and a higher number of co-infection (≥ 2 episodes) (OR 7, CI 95% 1.3-10.8;p = 0.01). Conclusion: These alarming findings emphasize the urgent need of a proper management of bacterial nosocomial infection in COVID-19 intensive care units to prevent mortality and critical situations.