Baccolini V, Migliara G, Isonne C, Dorelli B, Barone L C, Giannini D, Marotta D, Marte M, Mazzalai E, Alessandri F, Pugliese F, Ceccarelli G, De Vito C, Marzuillo C, De Giusti M, Villari P
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
Department of Anaesthesia and Intensive Care Medicine, Umberto I Teaching Hospital, Sapienza University of Rome, Rome, Italy.
Antimicrob Resist Infect Control. 2021 Jun 4;10(1):87. doi: 10.1186/s13756-021-00959-y.
During the intensive care units' (ICUs) reorganization that was forced by the COVID-19 emergency, attention to traditional infection control measures may have been reduced. Nevertheless, evidence on the effect of the COVID-19 pandemic on healthcare-associated infections (HAIs) is still limited and mixed. In this study, we estimated the pandemic impact on HAI incidence and investigated the HAI type occurring in COVID-19 patients.
Patients admitted to the main ICU of the Umberto I teaching hospital of Rome from March 1st and April 4th 2020 were compared with patients hospitalized in 2019. We assessed the association of risk factors and time-to-first event through multivariable Fine and Grey's regression models, that consider the competitive risk of death on the development of HAI (Model 1) or device related-HAI (dr-HAI, Model 2) and provide estimates of the sub-distribution hazard ratio (SHR) and its associated confidence interval (CI). A subgroup analysis was performed on the 2020 cohort.
Data from 104 patients were retrieved. Overall, 59 HAIs were recorded, 32 of which occurred in the COVID-19 group. Patients admitted in 2020 were found to be positively associated with both HAI and dr-HAI onset (SHR: 2.66, 95% CI 1.31-5.38, and SHR: 10.0, 95% CI 1.84-54.41, respectively). Despite being not confirmed at the multivariable analysis, a greater proportion of dr-HAIs seemed to occur in COVID-19 patients, especially ventilator-associated pneumonia, and catheter-related urinary tract infections.
We observed an increase in the incidence of patients with HAIs, especially dr-HAIs, mainly sustained by COVID-19 patients. A greater susceptibility of these patients to device-related infections was hypothesized, but further studies are needed.
在因新型冠状病毒肺炎（COVID-19）疫情而被迫进行的重症监护病房（ICU）重组期间，对传统感染控制措施的关注可能有所减少。然而，关于COVID-19大流行对医疗相关感染（HAIs）影响的证据仍然有限且不一致。在本研究中，我们估计了大流行对HAI发病率的影响，并调查了COVID-19患者中发生的HAI类型。
将2020年3月1日至4月4日入住罗马翁贝托一世教学医院主ICU的患者与2019年住院的患者进行比较。我们通过多变量Fine和Grey回归模型评估了风险因素与首次事件发生时间的关联，该模型考虑了HAI（模型1）或与设备相关的HAI（dr-HAI，模型2）发生时死亡的竞争风险，并提供了亚分布风险比（SHR）及其相关置信区间（CI）的估计值。对2020年队列进行了亚组分析。
检索到104例患者的数据。总体而言，记录了59例HAIs，其中32例发生在COVID-19组。发现2020年入院的患者与HAI和dr-HAI的发生均呈正相关（SHR分别为：2.66，95%CI 1.31 - 5.38；SHR为：10.0，95%CI 1.84 - 54.41）。尽管在多变量分析中未得到证实，但似乎有更大比例的dr-HAIs发生在COVID-19患者中，尤其是呼吸机相关性肺炎和导管相关尿路感染。
我们观察到HAIs患者的发病率有所增加，尤其是dr-HAIs，主要由COVID-19患者导致。推测这些患者对与设备相关感染的易感性更高，但仍需要进一步研究。
