Department of Pulmonary & Critical Care, Northeast Georgia Health System, Gainesville, GA, USA.
Department of Internal Medicine, Northeast Georgia Health System, Gainesville, GA, USA.
Int J Infect Dis. 2021 Mar;104:287-292. doi: 10.1016/j.ijid.2020.11.135. Epub 2020 Nov 15.
Healthcare-associated infections (HAI) after viral illnesses are important sources of morbidity and mortality. This has not been extensively studied in hospitalized COVID-19 patients.
This study included all COVID-19-positive adult patients (≥18 years) hospitalized between 01 March and 05 August 2020 at the current institution. The Centers for Disease Control and Prevention definition of HAI in the acute care setting was used. The outcomes that were studied were rates and types of infections and in-hospital mortality. Several multivariable logistic regression models were constructed to examine characteristics associated with development of HAI.
Fifty-nine (3.7%) of 1565 patients developed 140 separate HAIs from 73 different organisms: 23 were Gram-positive, 39 were Gram-negative and 11 were fungal. Patients who developed HAI did not have higher odds of death (OR 0.85, 95% CI 0.40-1.81, p = 0.69). HAIs were associated with the use of tocilizumab (OR 5.04, 95% CI 2.4-10.6, p < 0.001), steroids (OR 3.8, 95% CI 1.4-10, p = 0.007), hydroxychloroquine (OR 3.0, 95% CI 1.0-8.8, p = 0.05), and acute kidney injury requiring hemodialysis (OR 3.7, 95% CI 1.1-12.8, p = 0.04).
HAI were common in hospitalized Covid-19 patients. Tocilizumab and steroids were associated with increased risk of HAIs.
病毒性疾病后发生的医源性感染（HAI）是发病率和死亡率的重要来源。但这在住院的 COVID-19 患者中尚未得到广泛研究。
本研究纳入了 2020 年 3 月 1 日至 8 月 5 日期间，在本机构住院的所有（≥18 岁）COVID-19 阳性成年患者。采用美国疾病控制与预防中心在急性护理环境中对 HAI 的定义。研究的结局是感染率和类型以及住院死亡率。构建了几个多变量逻辑回归模型，以检查与 HAI 发生相关的特征。
在 1565 名患者中，有 59 名（3.7%）患者发生了 140 例由 73 种不同病原体引起的单独 HAI：23 例为革兰氏阳性菌，39 例为革兰氏阴性菌，11 例为真菌。发生 HAI 的患者死亡的几率没有更高（比值比 0.85，95%置信区间 0.40-1.81，p=0.69）。HAI 与托珠单抗（比值比 5.04，95%置信区间 2.4-10.6，p<0.001）、皮质类固醇（比值比 3.8，95%置信区间 1.4-10，p=0.007）、羟氯喹（比值比 3.0，95%置信区间 1.0-8.8，p=0.05）和需要血液透析的急性肾损伤（比值比 3.7，95%置信区间 1.1-12.8，p=0.04）的使用有关。
在住院的 COVID-19 患者中，HAI 很常见。托珠单抗和皮质类固醇与 HAI 风险增加有关。
