在入住重症监护病房的 COVID-19 患者和非 COVID-19 患者中，细菌和真菌呼吸道分离株的变化模式。
The changing pattern of bacterial and fungal respiratory isolates in patients with and without COVID-19 admitted to intensive care unit.
机构信息
Infectious Diseases Unit, ASST "Papa Giovanni XXIII", Piazza OMS, 1, 24127, Bergamo, Italy.
Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Bergamo, Italy.
出版信息
BMC Infect Dis. 2022 Feb 23;22(1):185. doi: 10.1186/s12879-022-07176-x.
OBJECTIVES
Severe acute respiratory syndrome 2 (SARS-CoV-2) pandemic has had a heavy impact on national health system, especially in the first wave. That impact hit principally the intensive care units (ICUs). The large number of patients requiring hospitalization in ICUs lead to a complete upheaval of intensive wards. The increase in bed, the fewer number of nurses per patient, the constant use of personal protective equipment, the new antimicrobial surveillance protocols could have had deeply effects on microbiological flora of these wards. Moreover, the overconsumption of antimicrobial therapy in COVID-19 patients, like several studies report, could have impact of this aspect. Aim of this study is to evaluate the changing pattern of microbiological respiratory isolates during and before COVID-19 pandemic in a tertiary hospital ICUs.
METHODS
A retrospective, observational study was conducted in ICUs of "ASST Papa Giovanni XXIII", a large tertiary referral hospital in Northern Italy. We have retrospectively collected the microbiological data from bronchoalveolar lavage (BAL) and tracheal aspirate (TA) of patients with COVID-19, hospitalized in ICUs from 22nd February 2020 to 31st May 2020 (Period 1), and without COVID-19, from 22nd February 2019 to 31st May 2019 (Period 2). We compared the prevalence and the antibiotic profile of bacterial and fungal species in the two time periods.
RESULTS
The prevalence of Pseudomonas spp. shows a statistically significant increase from patients without COVID-19 compared to COVID-19 positive as well as the prevalence of Enterococcus spp. On the contrary, the prevalence of Gram negative non fermenting bacteria (GN-NFB), Haemophilus influenzae and Streptococcus pneumoniae showed a significant reduction between two periods. There was a statistically significant increase in resistance of Pseudomonas spp. to carbapenems and piperacillin/tazobactam and Enterobacterales spp. for piperacillin/tazobactam, in COVID-19 positive patients compared to patients without COVID-19. We did not observe significant changing in fungal respiratory isolates.
CONCLUSIONS
A changing pattern in prevalence and resistance profiles of bacterial and fungal species was observed during COVID-19 pandemic.
目的
严重急性呼吸系统综合征 2 型（SARS-CoV-2）大流行对国家卫生系统造成了沉重打击，尤其是在第一波疫情中。这种影响主要冲击了重症监护病房（ICU）。大量需要住院治疗的患者导致 ICU 病房完全混乱。病床数量增加，每位患者的护士人数减少，持续使用个人防护设备，新的抗菌药物监测方案可能对这些病房的微生物区系产生深远影响。此外，正如多项研究报道的那样，COVID-19 患者过度使用抗菌药物治疗也可能对此产生影响。本研究旨在评估在意大利北部一家三级医院 ICU 中，COVID-19 大流行期间和之前微生物呼吸分离株的变化模式。
方法
我们在意大利北部的一家大型三级转诊医院“ASST Papa Giovanni XXIII”的 ICU 中进行了回顾性、观察性研究。我们回顾性地收集了 2020 年 2 月 22 日至 2020 年 5 月 31 日期间 COVID-19 患者（第 1 期）和 2019 年 2 月 22 日至 2019 年 5 月 31 日期间无 COVID-19 患者（第 2 期）支气管肺泡灌洗（BAL）和气管抽吸物（TA）的微生物数据。我们比较了两个时期细菌和真菌种类的流行率和抗生素谱。
结果
与 COVID-19 阳性患者相比，无 COVID-19 患者的铜绿假单胞菌和肠球菌的流行率呈统计学显著增加。相反，革兰氏阴性非发酵菌（GN-NFB）、流感嗜血杆菌和肺炎链球菌的流行率在两个时期之间显著降低。与无 COVID-19 的患者相比，COVID-19 阳性患者的铜绿假单胞菌对碳青霉烯类和哌拉西林/他唑巴坦以及肠杆菌科对哌拉西林/他唑巴坦的耐药率呈统计学显著增加。我们没有观察到真菌呼吸分离株有显著变化。
结论
在 COVID-19 大流行期间，观察到细菌和真菌种类的流行率和耐药谱发生变化。
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