Massart Nicolas, Maxime Virginie, Fillatre Pierre, Razazi Keyvan, Ferré Alexis, Moine Pierre, Legay Francois, Voiriot Guillaume, Amara Marlene, Santi Francesca, Nseir Saad, Marque-Juillet Stephanie, Bounab Rania, Barbarot Nicolas, Bruneel Fabrice, Luyt Charles-Edouard
Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France.
Surgical and Medical Intensive Care Unit Hôpital, Raymond Poincaré, 9230, Garches, France.
Ann Intensive Care. 2021 Dec 24;11(1):183. doi: 10.1186/s13613-021-00971-w.
Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring intensive care unit (ICU) have a high incidence of hospital-acquired infections; however, data regarding hospital acquired bloodstream infections (BSI) are scarce. We aimed to investigate risk factors and outcome of BSI in critically ill coronavirus infectious disease-19 (COVID-19) patients.
We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU study) that included 4010 COVID-19 ICU patients. For the present analysis, only those with data regarding primary outcome (death within 90 days from admission) or BSI status were included. Risk factors for BSI were analyzed using Fine and Gray competing risk model. Then, for outcome comparison, 537 BSI-patients were matched with 537 controls using propensity score matching.
Among 4010 included patients, 780 (19.5%) acquired a total of 1066 BSI (10.3 BSI per 1000 patients days at risk) of whom 92% were acquired in the ICU. Higher SAPS II, male gender, longer time from hospital to ICU admission and antiviral drug before admission were independently associated with an increased risk of BSI, and interestingly, this risk decreased over time. BSI was independently associated with a shorter time to death in the overall population (adjusted hazard ratio (aHR) 1.28, 95% CI 1.05-1.56) and, in the propensity score matched data set, patients with BSI had a higher mortality rate (39% vs 33% p = 0.036). BSI accounted for 3.6% of the death of the overall population.
COVID-19 ICU patients have a high risk of BSI, especially early after ICU admission, risk that increases with severity but not with corticosteroids use. BSI is associated with an increased mortality rate.
感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）且需要重症监护病房（ICU）治疗的患者医院获得性感染发生率很高；然而，关于医院获得性血流感染（BSI）的数据却很稀少。我们旨在调查危重新型冠状病毒感染疾病-19（COVID-19）患者发生BSI的危险因素及结局。
我们对一项多中心前瞻性国际队列研究（COVID-ICU研究）进行了辅助分析，该研究纳入了4010例COVID-19 ICU患者。对于本次分析，仅纳入那些有主要结局（入院后90天内死亡）或BSI状态数据的患者。使用Fine和Gray竞争风险模型分析BSI的危险因素。然后，为了进行结局比较，采用倾向评分匹配法将537例发生BSI的患者与537例对照进行匹配。
在纳入的4010例患者中，780例（19.5%）共发生1066次BSI（每1000患者日有风险日的BSI发生率为10.3次），其中92%是在ICU获得的。较高的简化急性生理学评分系统II（SAPS II）、男性、从医院到入住ICU的时间较长以及入院前使用抗病毒药物与BSI风险增加独立相关，有趣的是，这种风险随时间降低。在总体人群中，BSI与较短的死亡时间独立相关（校正风险比[aHR]为1.28，95%置信区间为1.05-1.56），并且在倾向评分匹配数据集中，发生BSI的患者死亡率更高（39%对33%，p = 0.036）。BSI占总体人群死亡人数的3.6%。
COVID-19 ICU患者发生BSI的风险很高，尤其是在入住ICU后的早期，该风险随病情严重程度增加而增加，但与使用皮质类固醇无关。BSI与死亡率增加相关。
