We collected the following data from the electronic medical records: demographic characteristics, medical comorbidities, SOFA score, APACHE II score, source of infection, bacterial and fungal species, severity of systemic inflammatory response, and clinical outcome. We only included in the study cases with confirmed infection, defined by the presence of a positive culture of a significant clinical sample, associated with clinical signs of infection and/or worsening organ failure. Conventional microbiological testing (tracheal aspirate, blood and urine cultures) was requested by the treating physician when infection was suspected, and was not protocolized. Cases were reviewed by an Infectious Diseases specialist and an Anaesthesia specialist to determine the presence of true clinical co-infection and its source. All infections were defined according to the Centers for Disease Control and Prevention criteria and the Spanish Society of Infectious Diseases and Clinical Microbiology [7, 8]; the severity of infection and the presence of septic shock followed Sepsis-3 definitions [9]. If a diagnosis of co-infection was made within the first 48 h since hospital admission, these infections were defined as community-acquired. If diagnosis occurred ≥ 48 h from admission for COVID-19, these infections were defined as hospital-acquired superinfections. All patients were treated according to the institution COVID-19 protocol and all the revisions published throughout the outbreak following the appearance of new scientific evidence regarding treatment drugs. Moreover, the hospital ICUs apply the care bundles of the national Spanish guidelines with regard to IV lines and tracheal tube handling [10, 11]. Microorganisms were defined as multidrug resistant (MDR) if they were resistant to ≥ 1 drug in at least 3 classes of antibiotics, and XDR if resistant to ≥ 1 drug in all but ≤ 2 classes of antibiotics [12]. Outcome variables were ICU mortality, and mortality at hospital discharge, which was recorded for all patients.

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