Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy.
Eur J Clin Invest. 2021 Dec;51(12):e13687. doi: 10.1111/eci.13687. Epub 2021 Oct 11.
BACKGROUND/OBJECTIVES: We investigated whether behavioral precautions adopted during Coronavirus disease (COVID-19) pandemic also influenced the spreading and multidrug resistance (MDR) of ESKAPEEc (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii [AB], Pseudomonas aeruginosa, Enterobacter spp and Escherichia Coli, [EC]) among Intensive Care Unit (ICU) patients.
SUBJECTS/METHODS: We performed a single-center retrospective study in adult patients admitted to our COVID-19-free surgical ICU. Only patients staying in ICU for more than 48 hours were included. The ESKAPEEc infections recorded during the COVID-19 period (June 1, 2020 - February 28, 2021) and in the corresponding pre-pandemic period (June 1, 2019 - February 28, 2020) were compared. An interrupted time series analysis was performed to rule out possible confounders.
Overall, 173 patients in the COVID-19 period and 132 in the pre-COVID-19 period were investigated. The ESKAPEEc infections were documented in 23 (13.3%) and 35 (26.5%) patients in the pandemic and the pre-pandemic periods, respectively (p = 0.005). Demographics, diagnosis, comorbidities, type of surgery, Simplified Acute Physiology Score II, length of mechanical ventilation, hospital and ICU length of stay, ICU death rate, and 28-day hospital mortality were similar in the two groups. In comparison with the pre-pandemic period, no AB was recorded during COVID-19 period, (p = 0.017), while extended-spectrum beta-lactamase-producing EC infections significantly decreased (p = 0.017). Overall, the ESKAPEEc isolates during pandemic less frequently exhibited multidrug-resistant (p = 0.014).
These findings suggest that a robust adherence to hygiene measures together with human contact restrictions in a COVID-19 free ICU might also restrain the transmission of ESKAPEEc pathogens.
背景/目的：我们研究了在冠状病毒病（COVID-19）大流行期间采取的行为预防措施是否也会影响重症监护病房（ICU）患者中 ESKAPEEc（屎肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌[AB]、铜绿假单胞菌、肠杆菌属和大肠埃希菌，[EC]）的传播和多重耐药（MDR）。
对象/方法：我们对我院 COVID-19 免费外科 ICU 收治的成年患者进行了一项单中心回顾性研究。仅纳入在 ICU 停留超过 48 小时的患者。比较了 COVID-19 期间（2020 年 6 月 1 日-2021 年 2 月 28 日）和相应大流行前期间（2019 年 6 月 1 日-2020 年 2 月 28 日）记录的 ESKAPEEc 感染。进行了中断时间序列分析以排除可能的混杂因素。
共有 COVID-19 期间的 173 例和大流行前期间的 132 例患者接受了调查。在大流行和大流行前期间，分别有 23（13.3%）和 35（26.5%）患者记录到 ESKAPEEc 感染（p=0.005）。两组患者的人口统计学、诊断、合并症、手术类型、简化急性生理学评分 II、机械通气时间、住院和 ICU 住院时间、ICU 死亡率和 28 天院内死亡率相似。与大流行前期间相比，COVID-19 期间未记录到 AB（p=0.017），而产超广谱β-内酰胺酶的 EC 感染显著减少（p=0.017）。总体而言，大流行期间 ESKAPEEc 分离株的多重耐药性较低（p=0.014）。
这些发现表明，在 COVID-19 免费 ICU 中严格遵守卫生措施并限制人员接触，可能也会限制 ESKAPEEc 病原体的传播。
