Hospital Unimed-Rio, Unidade de Terapia Intensiva, Rio de Janeiro, Rio de Janeiro, Brazil.
Instituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro, Brazil.
Rev Inst Med Trop Sao Paulo. 2022 Feb 2;64:e6. doi: 10.1590/S1678-9946202264006. eCollection 2022.
Some studies have shown that secondary infections during the COVID-19 pandemic may have contributed to the high mortality. Our objective was to identify the frequency, types and etiology of bacterial infections in patients with COVID-19 admitted to an intensive care unit (ICU) and to evaluate the results of ICU stay, duration of mechanical ventilation (MV) and in-hospital mortality. It was a single-center study with a retrospective cohort of patients admitted consecutively to the ICU for more than 48 h between March and May 2020. Comparisons of groups with and without ICU- acquired infection were performed. A total of 191 patients with laboratory-confirmed COVID-19 were included and 57 patients had 97 secondary infectious events. The most frequent agents were Acinetobacter baumannii (28.9%), Pseudomonas aeruginosa (22.7%) and Klebsiella pneumoniae (14.4%); multi-drug resistance was present in 96% of A. baumannii and in 57% of K. pneumoniae. The most prevalent infection was ventilator-associated pneumonia in 57.9% of patients with bacterial infections, or 17.3% of all COVID-19 patients admitted to the ICU, followed by tracheobronchitis (26.3%). Patients with secondary infections had a longer ICU stay (40.0 vs. 17 days; p < 0.001), as well as a longer duration of MV (24.0 vs 9.0 days; p= 0.003). There were 68 (35.6%) deaths overall, of which 27 (39.7%) patients had bacterial infections. Among the 123 survivors, 30 (24.4%) had a secondary infections (OR 2.041; 95% CI 1.080 - 3.859). A high incidence of secondary infections, mainly caused by gram-negative bacteria has been observed. Secondary infections were associated with longer ICU stay, MV use and higher mortality.
一些研究表明，COVID-19 大流行期间的继发感染可能导致高死亡率。我们的目的是确定入住重症监护病房（ICU）的 COVID-19 患者中细菌感染的频率、类型和病因，并评估 ICU 住院时间、机械通气（MV）持续时间和住院死亡率。这是一项单中心研究，对 2020 年 3 月至 5 月期间连续入住 ICU 超过 48 小时的患者进行了回顾性队列研究。比较了有和无 ICU 获得性感染的患者。共纳入 191 例经实验室确诊的 COVID-19 患者，57 例患者发生 97 例继发感染事件。最常见的病原体是鲍曼不动杆菌（28.9%）、铜绿假单胞菌（22.7%）和肺炎克雷伯菌（14.4%）；鲍曼不动杆菌的多重耐药率为 96%，肺炎克雷伯菌为 57%。最常见的感染是细菌性感染患者中有 57.9%发生呼吸机相关性肺炎，或 ICU 收治的所有 COVID-19 患者中有 17.3%发生呼吸机相关性肺炎，其次是气管支气管炎（26.3%）。继发感染患者 ICU 住院时间（40.0 与 17 天；p<0.001）和 MV 持续时间（24.0 与 9.0 天；p=0.003）均较长。总共有 68 例（35.6%）死亡，其中 27 例（39.7%）患者发生细菌感染。在 123 例存活患者中，30 例（24.4%）发生二次感染（OR 2.041；95%CI 1.080-3.859）。观察到继发性感染发生率较高，主要由革兰氏阴性菌引起。继发感染与 ICU 住院时间延长、MV 使用和死亡率升高有关。
