Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.
Clin Microbiol Infect. 2021 Dec;27(12):1772-1776. doi: 10.1016/j.cmi.2021.06.001. Epub 2021 Jun 7.
BACKGROUND: A wide range of bacterial infections occur in coronavirus disease 2019 (COVID-19) patients, particularly in those with severe coronaviral disease. Some of these are community-acquired co-infections. OBJECTIVE: To review recent data that indicate the occurrence of hospital-onset bacterial infections, including with antibiotic-resistant isolates, in COVID-19 patients. SOURCES: Using PubMed, the literature was searched using terms including: 'COVID-19'; 'SARS-CoV-2'; 'bacterial infection'; 'healthcare-associated infection'; 'antibiotic resistance'; 'antimicrobial resistance'; 'multi-drug resistance'; 'Streptococcus'; 'Staphylococcus'; 'Pseudomonas'; 'Escherichia'; 'Klebsiella'; 'Enterococcus'; 'Acinetobacter'; 'Haemophilus'; 'MRSA'; 'VRE'; 'ESBL'; 'NDM-CRE'; 'CR-Ab'; 'VRSA'; 'MDR'. CONTENT: There is a growing number of reports of bacterial infections acquired by patients with severe COVID-19 after hospital admission. Antibiotic-resistant pathogens found to cause healthcare-associated infections (HAIs) in COVID-19 patients include methicillin-resistant Staphylococcus aureus, New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, extended-spectrum β-lactamase Klebsiella pneumoniae and vancomycin-resistant enterococci. COVID-19 has impacted bacterial HAIs in a number of ways with an increase in the incidence of New Delhi metallo-β-lactamase-producing carbapenem-resistant Enterobacterales and carbapenem-resistant A. baumannii reported at some hospital sites compared with before the pandemic. Recommended guidelines for antimicrobial stewardship in COVID-19 patient treatment are discussed regarding minimization of empiric broad-spectrum antibiotic use. Other studies have reported a decrease in methicillin-resistant S. aureus and vancomycin-resistant enterococci cases, which has been attributed to enhanced infection prevention and control practices introduced to minimize intra-hospital spread of COVID-19. IMPLICATIONS: Poorer outcomes have been observed in hospitalized COVID-19 patients with an antibiotic-resistant infection. Although heightened IPC measures have been accompanied by a reduction in some HAIs at specific sites, in other situations, COVID-19 has been associated with an increase in bacterial HAI incidence. Further research is needed to define the cost-benefit relationship of maintaining COVID-19-related infection prevention and control protocols beyond the pandemic to reduce the burden of HAIs. In addition, the longer-term impact of high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic requires evaluation.
背景:在 COVID-19 患者中,会发生多种细菌感染,尤其是在严重冠状病毒病患者中。其中一些是社区获得性合并感染。
目的:综述近期数据,以明确 COVID-19 患者中出现的医院获得性细菌感染,包括抗生素耐药分离株。
资料来源:使用 PubMed,通过包括以下术语进行文献检索:“COVID-19”;“SARS-CoV-2”;“细菌感染”;“医院获得性感染”;“抗生素耐药性”;“抗微生物药物耐药性”;“多药耐药性”;“链球菌”;“葡萄球菌”;“假单胞菌”;“大肠埃希菌”;“克雷伯菌”;“肠球菌”;“不动杆菌”;“流感嗜血杆菌”;“MRSA”;“VRE”;“ESBL”;“NDM-CRE”;“CR-Ab”;“VRSA”;“MDR”。
内容:越来越多的报道表明,严重 COVID-19 患者入院后会获得细菌感染。在 COVID-19 患者中导致医院获得性感染(HAI)的抗生素耐药病原体包括耐甲氧西林金黄色葡萄球菌、产生新德里金属β-内酰胺酶的耐碳青霉烯肠杆菌科、耐碳青霉烯鲍曼不动杆菌、产超广谱β-内酰胺酶肺炎克雷伯菌和万古霉素耐药肠球菌。COVID-19 通过多种方式影响细菌 HAI,与大流行前相比,一些医院报道称,产生新德里金属β-内酰胺酶的耐碳青霉烯肠杆菌科和耐碳青霉烯鲍曼不动杆菌的发生率增加。讨论了针对 COVID-19 患者治疗的抗菌药物管理推荐指南,以减少经验性广谱抗生素的使用。其他研究报告称耐甲氧西林金黄色葡萄球菌和万古霉素耐药肠球菌病例减少,这归因于为最大程度减少 COVID-19 医院内传播而引入的强化感染预防和控制措施。
结论:住院 COVID-19 患者发生抗生素耐药感染时,预后较差。尽管加强了 IPC 措施,但在某些情况下,某些 HAI 有所减少,但在其他情况下,COVID-19 与 HAI 发生率增加有关。需要进一步研究,以确定在大流行后维持 COVID-19 相关感染预防和控制方案以降低 HAI 负担的成本效益关系。此外,需要评估在 COVID-19 大流行期间广泛使用某些广谱抗生素的长期影响。
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