Contou Damien, Claudinon Aurore, Pajot Olivier, Micaëlo Maïté, Longuet Flandre Pascale, Dubert Marie, Cally Radj, Logre Elsa, Fraissé Megan, Mentec Hervé, Plantefève Gaëtan
Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.
Service de Microbiologie, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.
Ann Intensive Care. 2020 Sep 7;10(1):119. doi: 10.1186/s13613-020-00736-x.
Data on the prevalence of bacterial and viral co-infections among patients admitted to the ICU for acute respiratory failure related to SARS-CoV-2 pneumonia are lacking. We aimed to assess the rate of bacterial and viral co-infections, as well as to report the most common micro-organisms involved in patients admitted to the ICU for severe SARS-CoV-2 pneumonia.
In this monocenter retrospective study, we reviewed all the respiratory microbiological investigations performed within the first 48 h of ICU admission of COVID-19 patients (RT-PCR positive for SARS-CoV-2) admitted for acute respiratory failure.
From March 13th to April 16th 2020, a total of 92 adult patients (median age: 61 years, 1st-3rd quartiles [55-70]; males: n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation: n = 83/92, 90%; ICU mortality: n = 45/92, 49%) were admitted to our 40-bed ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. Among them, 26 (28%) were considered as co-infected with a pathogenic bacterium at ICU admission with no co-infection related to atypical bacteria or viruses. The distribution of the 32 bacteria isolated from culture and/or respiratory PCRs was as follows: methicillin-sensitive Staphylococcus aureus (n = 10/32, 31%), Haemophilus influenzae (n = 7/32, 22%), Streptococcus pneumoniae (n = 6/32, 19%), Enterobacteriaceae (n = 5/32, 16%), Pseudomonas aeruginosa (n = 2/32, 6%), Moraxella catarrhalis (n = 1/32, 3%) and Acinetobacter baumannii (n = 1/32, 3%). Among the 24 pathogenic bacteria isolated from culture, 2 (8%) and 5 (21%) were resistant to 3rd generation cephalosporin and to amoxicillin-clavulanate combination, respectively.
We report on a 28% rate of bacterial co-infection at ICU admission of patients with severe SARSCoV-2 pneumonia, mostly related to Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Enterobacteriaceae. In French patients with confirmed severe SARSCoV-2 pneumonia requiring ICU admission, our results encourage the systematic administration of an empiric antibiotic monotherapy with a 3rd generation cephalosporin, with a prompt de-escalation as soon as possible. Further larger studies are needed to assess the real prevalence and the predictors of co-infection together with its prognostic impact on critically ill patients with severe SARS-CoV-2 pneumonia.
目前缺乏因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）肺炎导致急性呼吸衰竭而入住重症监护病房（ICU）患者的细菌和病毒合并感染患病率数据。我们旨在评估细菌和病毒合并感染率，并报告因严重SARS-CoV-2肺炎入住ICU患者中最常见的相关微生物。
在这项单中心回顾性研究中，我们回顾了因急性呼吸衰竭入住ICU的新型冠状病毒肺炎（COVID-19）患者（SARS-CoV-2逆转录聚合酶链反应[RT-PCR]检测呈阳性）在入住ICU的前48小时内进行的所有呼吸道微生物学检查。
2020年3月13日至4月16日，共有92例成年患者（中位年龄：61岁，第1-3四分位数[55-70]；男性：n = 73/92，79%；基线序贯器官衰竭评估（SOFA）评分：4[3-7]，简化急性生理学评分（SAPS）II：31[21-40]；有创机械通气：n = 83/92，90%；ICU死亡率：n = 45/92，49%）因SARS-CoV-2肺炎导致急性呼吸衰竭入住我们拥有40张床位的ICU。其中，26例（28%）在入住ICU时被认为合并有病原菌感染，无合并非典型细菌或病毒感染。从培养和/或呼吸道PCR检测中分离出的32种细菌分布如下：甲氧西林敏感金黄色葡萄球菌（n = 10/32，31%）、流感嗜血杆菌（n = 7/32，22%）、肺炎链球菌（n = 6/32，19%）、肠杆菌科细菌（n = 5/32，16%）、铜绿假单胞菌（n = 2/32，6%）、卡他莫拉菌（n = 1/32，3%）和鲍曼不动杆菌（n = 1/32，3%）。从培养物中分离出的24种病原菌中，分别有2种（8%）和5种（21%）对第三代头孢菌素和阿莫西林-克拉维酸组合耐药。
我们报告了因严重SARS-CoV-2肺炎入住ICU的患者中细菌合并感染率为28%，主要与金黄色葡萄球菌、流感嗜血杆菌、肺炎链球菌和肠杆菌科细菌有关。对于确诊为严重SARS-CoV-2肺炎且需要入住ICU的法国患者，我们的结果支持系统性给予第三代头孢菌素经验性单药抗生素治疗，并尽快进行降阶梯治疗。需要进一步开展更大规模的研究，以评估合并感染的实际患病率和预测因素，以及其对重症SARS-CoV-2肺炎危重症患者的预后影响。
