COVID-19 与非 COVID-19 患者呼吸机相关性下呼吸道细菌感染比较。

Ventilator-Associated Lower Respiratory Tract Bacterial Infections in COVID-19 Compared With Non-COVID-19 Patients.

机构信息

Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.

Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

出版信息

Crit Care Med. 2022 May 1;50(5):825-836. doi: 10.1097/CCM.0000000000005462. Epub 2022 Feb 14.

DOI:10.1097/CCM.0000000000005462

PMID:35148524

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9005099/

Abstract

OBJECTIVES: Ventilator-associated lower respiratory tract infections (VA-LRTIs) are associated with prolonged length of stay and increased mortality. We aimed to investigate the occurrence of bacterial VA-LRTI among mechanically ventilated COVID-19 patients and compare these findings to non-COVID-19 cohorts throughout the first and second wave of the pandemic. DESIGN: Retrospective cohort study. SETTING: Karolinska University Hospital, Stockholm, Sweden. PATIENTS: All patients greater than or equal to 18 years treated with mechanical ventilation between January 1, 2011, and December 31, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The cohort consisted of 20,223 ICU episodes (479 COVID-19), with a VA-LRTI incidence proportion of 30% (129/426) in COVID-19 and 18% (1,081/5,907) in non-COVID-19 among patients ventilated greater than or equal to 48 hours. The median length of ventilator treatment for COVID-19 patients was 10 days (interquartile range, 5-18 d), which was significantly longer than for all other investigated specific diagnoses. The VA-LRTI incidence rate per 1,000 ventilator days at risk was 31 (95% CI, 26-37) for COVID-19 and 34 (95% CI, 32-36) for non-COVID-19. With COVID-19 as reference, adjusted subdistribution hazard ratios for VA-LRTI was 0.29-0.50 (95% CI, < 1) for influenza, bacterial pneumonia, acute respiratory distress syndrome, and severe sepsis, but 1.38 (95% CI, 1.15-1.65) for specific noninfectious diagnoses. Compared with COVID-19 in the first wave of the pandemic, COVID-19 in the second wave had adjusted subdistribution hazard ratio of 1.85 (95% CI, 1.14-2.99). In early VA-LRTI Staphylococcus aureus was more common and Streptococcus pneumoniae, Haemophilus influenzae, and Escherichia coli less common in COVID-19 patients, while Serratia species was more often identified in late VA-LRTI. CONCLUSIONS: COVID-19 is associated with exceptionally long durations of mechanical ventilation treatment and high VA-LRTI occurrence proportions. The incidence rate of VA-LRTI was compared with the pooled non-COVID-19 cohort, however, not increased in COVID-19. Significant differences in the incidence of VA-LRTI occurred between the first and second wave of the COVID-19 pandemic.

摘要

目的：呼吸机相关性下呼吸道感染（VA-LRTI）与住院时间延长和死亡率增加有关。本研究旨在调查 COVID-19 机械通气患者中细菌 VA-LRTI 的发生情况，并将这些发现与大流行第一波和第二波期间的非 COVID-19 队列进行比较。

设计：回顾性队列研究。

地点：瑞典斯德哥尔摩卡罗林斯卡大学医院。

患者：2011 年 1 月 1 日至 2020 年 12 月 31 日期间接受机械通气治疗且年龄大于等于 18 岁的所有患者。

干预措施：无。

测量和主要结果：该队列包括 20,223 例 ICU 病例（479 例 COVID-19），COVID-19 患者中 VA-LRTI 的发生率比例为 30%（129/426），非 COVID-19 患者中为 18%（1,081/5,907）。在接受机械通气治疗大于或等于 48 小时的患者中。COVID-19 患者的中位呼吸机治疗时间为 10 天（四分位间距，5-18 d），明显长于所有其他调查的特定诊断。COVID-19 患者每 1,000 个呼吸机治疗日的 VA-LRTI 发病率为 31（95%CI，26-37），而非 COVID-19 患者为 34（95%CI，32-36）。以 COVID-19 为参照，VA-LRTI 的调整亚分布危险比为流感、细菌性肺炎、急性呼吸窘迫综合征和严重败血症的 0.29-0.50（95%CI，<1），但特定非传染性诊断的为 1.38（95%CI，1.15-1.65）。与大流行第一波中的 COVID-19 相比，大流行第二波中的 COVID-19 的调整亚分布危险比为 1.85（95%CI，1.14-2.99）。在早期 VA-LRTI 中，金黄色葡萄球菌更为常见，肺炎链球菌、流感嗜血杆菌和大肠埃希菌较少见，而在 COVID-19 患者中，阴沟肠杆菌更为常见，而沙雷氏菌则在晚期 VA-LRTI 中更为常见。

结论：COVID-19 与机械通气治疗时间延长和高 VA-LRTI 发生率比例有关。VA-LRTI 的发病率与非 COVID-19 队列进行了比较，但 COVID-19 患者并未增加。COVID-19 大流行的第一波和第二波之间 VA-LRTI 的发病率存在显著差异。