Infectious Diseases Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy.
Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Eur J Clin Invest. 2020 Oct;50(10):e13319. doi: 10.1111/eci.13319. Epub 2020 Aug 11.
Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19).
This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI.
Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall P for the dummy variable = 0.003).
The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.
关于 2019 年冠状病毒病（COVID-19）危重症患者重症加强治疗病房（ICU）获得性血流感染（BSI）的发生率和风险，知之甚少。
本回顾性单中心研究在意大利北部进行。主要研究目的如下：（a）评估 ICU 获得性 BSI 的发生率；（b）评估 ICU 获得性 BSI 的累积风险。
共有 78 例 COVID-19 危重症患者纳入研究。31 例患者中发生 45 例 ICU 获得性 BSI，每 1000 例风险患者日发生 47 例（95%置信区间[CI]35-63）。在 15 天风险后，发展至少一次 BSI 发作的估计累积风险接近 25%，在 30 天风险后可能超过 50%。多变量分析显示，抗炎治疗与 BSI 的发生独立相关（托珠单抗的特异性危险比[csHR]为 1.07，95%CI 为 0.38-3.04；甲泼尼龙的 csHR 为 3.95，95%CI 为 1.20-13.03；甲泼尼龙加托珠单抗的 csHR 为 10.69，95%CI 为 2.71-42.17；以无抗炎治疗为参照组；整体 P 值为 0.003）。
BSI 的发生率较高，ICU 入住时间增加，BSI 的累积风险也随之增加。进一步的研究将阐明我们在 COVID-19 患者中检测到的接受抗炎药物治疗的患者 BSI 风险增加是否超过了减轻任何由 SARS-CoV-2 引起的可能促炎失调的益处。
