Álvarez-Lerma F
Fundación Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España.
Enferm Intensiva. 2022 Sep;33:S1-S7. doi: 10.1016/j.enfi.2022.05.006. Epub 2022 Jul 15.
COVID-19 patients admitted to critical care units present an intense inflammatory response and the need to replace organs or systems for long periods of time, which facilitates the presence of infectious complications.
To present the national rates of infections related to invasive devices (IRDI) in COVID-19 patients, as well as the rates of multi-resistant bacteria (MBR) acquired during their stay in critical care units.
Retrospective analysis of COVID-19 patients included during the first, second and fourth waves of the pandemic in a national observational and multicenter database (ENVIN-HELICS). Pneumonias related to mechanical ventilation (N-MV), urinary tract infections related to urethral catheter (UTI-SU) and primary bacteremia related to central venous catheters (BP-CVC) were recorded, whose rates are presented as incidence density (ID). The BMRs acquired during the stay in the critical care units were recorded and presented as cumulative incidence (CI).
Seven thousand seven hundred seventy-eight patients were included, 1,525 (19.6%) in the first wave of the pandemic, 3,484 (44.8%) in the second, and 2,769 (35.6%) in the fourth. ICU stay of 21 days in the first and second waves and 19.7 days in the fourth. Intra-ICU mortality in the first wave, decreasing from 31% to 26.3% in the second and 18.9% in the fourth. N-MV rates of 14.31, 13.56, and 19.99 episodes per 1,000 days of MV in each wave. UTI-SU rates of 6.54, 5.63 and 7.97 episodes per 1000 days of SU. BP-CVC rates of 12.42, 7.95, and 8.13 per 1,000 CVC days. The BMR rate was 22.9, 15.3, and 15.3 BMR per 100 admitted patients.
High rates of the different IRDI in COVID patients that are maintained in the three waves analyzed. High rates of BMR acquired during the stay in critical care units with a tendency to decrease in the fourth wave.
入住重症监护病房的新冠肺炎患者会出现强烈的炎症反应，且需要长时间替代器官或系统，这使得感染并发症的发生更为常见。
呈现新冠肺炎患者中与侵入性装置相关的感染（IRDI）的全国发生率，以及他们在重症监护病房住院期间获得多重耐药菌（MBR）的发生率。
对在全国性观察性多中心数据库（ENVIN-HELICS）中疫情第一、第二和第四波期间纳入的新冠肺炎患者进行回顾性分析。记录与机械通气相关的肺炎（N-MV）、与尿道导管相关的尿路感染（UTI-SU）以及与中心静脉导管相关的原发性菌血症（BP-CVC），其发生率以发病密度（ID）表示。记录在重症监护病房住院期间获得的多重耐药菌，并以累积发生率（CI）表示。
共纳入7778例患者，疫情第一波1525例（19.6%），第二波3484例（44.8%），第四波2769例（35.6%）。第一波和第二波患者在重症监护病房的住院时间为21天，第四波为19.7天。第一波患者在重症监护病房内的死亡率为31%，第二波降至26.3%，第四波为18.9%。每一波中每1000天机械通气的N-MV发生率分别为14.31、13.56和19.99例。每1000天导尿的UTI-SU发生率分别为6.54、5.63和7.97例。每1000个中心静脉导管日的BP-CVC发生率分别为12.42、7.95和8.13例。每100例入院患者的多重耐药菌发生率分别为22.9、15.3和15.3例。
在分析的三波疫情中，新冠肺炎患者中不同IRDI的发生率均较高。在重症监护病房住院期间获得多重耐药菌的发生率较高，且在第四波中有下降趋势。
