Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Infectious Diseases Department, Hospital Clinic of Barcelona-IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Int J Infect Dis. 2022 May;118:197-202. doi: 10.1016/j.ijid.2022.03.003. Epub 2022 Mar 5.
We described the current incidence and risk factors of bacterial co-infection in hospitalized patients with COVID-19.
Observational cohort study was performed at the Hospital Clinic of Barcelona (February 2020-February 2021). All patients with COVID-19 who were admitted for >48 hours with microbiological sample collection and procalcitonin (PCT) determination within the first 48 hours were included.
A total of 1125 consecutive adults met inclusion criteria. Co-infections were microbiologically documented in 102 (9.1%) patients. Most frequent microorganisms were Streptococcus pneumoniae (79%), Staphylococcus aureus (6.8%), and Haemophilus influenzae (6.8%). Test positivity was 1% (8/803) for blood cultures, 10.1% (79/780) for pneumococcal urinary antigen test, and 11.4% (15/132) for sputum culture. Patients with PCT higher than 0.2, 0.5, 1, and 2 ng/mL had significantly more co-infections than those with lower levels (p=0.017, p=0.031, p<0.001, and p<0.001, respectively). In multivariate analysis, oxygen saturation ≤94% (OR 2.47, CI 1.57-3.86), ferritin levels <338 ng/mL (OR 2.63, CI 1.69-4.07), and PCT higher than 0.2 ng/mL (OR 1.74, CI 1.11-2.72) were independent risk factors for co-infection at hospital admission owing to COVID-19.
Bacterial co-infection in patients hospitalized for COVID-19 is relatively common. However, clinicians could spare antibiotics in patients with PCT values <0.2, especially with high ferritin values and oxygen saturation >94%.
我们描述了住院 COVID-19 患者中细菌合并感染的当前发生率和危险因素。
在巴塞罗那临床医院进行了观察性队列研究（2020 年 2 月至 2021 年 2 月）。所有因 COVID-19 住院>48 小时且在最初 48 小时内采集了微生物样本并测定降钙素原（PCT）的患者均符合纳入标准。
共纳入 1125 例连续的成年人。102 例（9.1%）患者有合并感染的微生物学证据。最常见的微生物是肺炎链球菌（79%）、金黄色葡萄球菌（6.8%）和流感嗜血杆菌（6.8%）。血培养阳性率为 1%（8/803），肺炎球菌尿抗原检测阳性率为 10.1%（79/780），痰培养阳性率为 11.4%（15/132）。PCT 高于 0.2、0.5、1 和 2ng/mL 的患者合并感染的比例显著高于 PCT 较低水平的患者（p=0.017，p=0.031，p<0.001，p<0.001）。多变量分析显示，血氧饱和度≤94%（OR 2.47，95%CI 1.57-3.86）、铁蛋白水平<338ng/mL（OR 2.63，95%CI 1.69-4.07）和 PCT 高于 0.2ng/mL（OR 1.74，95%CI 1.11-2.72）是 COVID-19 住院患者合并感染的独立危险因素。
COVID-19 住院患者中细菌合并感染较为常见。然而，对于 PCT 值<0.2 的患者，特别是铁蛋白值高和血氧饱和度>94%的患者，可避免使用抗生素。
