Ruiz-Santana Sergio, Mora-Quintero María-Luisa, Saavedra Pedro, Montiel-González Raquel, Sánchez-Ramírez Catalina, Pérez-Acosta Guillermo, Martín-Velasco Mar, Rodríguez-Mata Cristóbal, Lorenzo-García José-Manuel, Parrilla-Toribio Dácil, Carrillo-García Tanya, Martín-González Juan-Carlos
Intensive Care Unit, Hospital Universitario Dr. Negrín, University of Las Palmas de Gran Canaria, Barranco de la Ballena s/n, E-35010 Las Palmas de Gran Canaria, Spain.
Intensive Care Unit, Hospital Universitario de Canarias (Tenerife), Carretera de Ofra s/n, E-38320 San Cristóbal de La Laguna, Spain.
Antibiotics (Basel). 2022 Jul 28;11(8):1016. doi: 10.3390/antibiotics11081016.
The incidence of secondary infections in critically ill coronavirus disease 2019 (COVID-19) patients is worrisome. We investigated whether selective digestive decontamination (SDD) added to infection control measures during an intensive care unit (ICU) stay modified these infection rates. Methods: A retrospective observational cohort study was carried out in four ICUs in Spain. All consecutive ventilated patients with a SARS-CoV-2 infection engaged in national infection control programs between 1 March and 10 December 2020 were investigated. Patients were grouped into two cohorts according to the site of ICU admission. Secondary relevant infections were included. Infection densities corresponding to ventilator-associated pneumonia (VAP), catheter bacteremia, secondary bacteremia, and multi-resistant germs were obtained as the number of events per 1000 days of exposure and were compared between SDD and non-SDD groups using Poisson regression. Factors that had an independent association with mortality were identified using multidimensional logistic analysis. Results: There were 108 patients in the SDD cohort and 157 in the non-SDD cohort. Patients in the SDD cohort showed significantly lower rates (p < 0.001) of VAP (1.9 vs. 9.3 events per 1000 ventilation days) and MDR infections (0.57 vs. 2.28 events per 1000 ICU days) and a non-significant reduction in secondary bacteremia (0.6 vs. 1.41 events per 1000 ICU days) compared with those in the non-SDD cohort. Infections caused by MDR pathogens occurred in 5 patients in the SDD cohort and 21 patients in the non-SDD cohort (p = 0.006). Differences in mortality according to SDD were not found. Conclusion: The implementation of SDD in infection control programs significantly reduced the incidence of VAP and MDR infections in critically ill SARS-CoV-2 infected patients.
2019年冠状病毒病（COVID-19）重症患者的继发感染发生率令人担忧。我们调查了在重症监护病房（ICU）住院期间，在感染控制措施基础上增加选择性消化道去污（SDD）是否会改变这些感染率。方法：在西班牙的四个ICU进行了一项回顾性观察队列研究。对2020年3月1日至12月10日期间参与国家感染控制项目的所有连续感染严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的通气患者进行调查。根据ICU入院地点将患者分为两个队列。纳入继发相关感染。获得与呼吸机相关性肺炎（VAP）、导管菌血症、继发菌血症和多重耐药菌对应的感染密度，以每1000天暴露事件数表示，并使用泊松回归在SDD组和非SDD组之间进行比较。使用多维度逻辑分析确定与死亡率有独立关联的因素。结果：SDD队列中有108例患者，非SDD队列中有157例患者。与非SDD队列相比，SDD队列中的患者VAP发生率（每1000个通气日1.9次事件对9.3次事件）和多重耐药菌感染率（每1000个ICU日0.57次事件对2.28次事件）显著降低（p<0.001），继发菌血症有非显著降低（每1000个ICU日0.6次事件对1.41次事件）。SDD队列中有5例患者发生多重耐药病原体感染，非SDD队列中有21例患者发生（p = 0.006）。未发现根据SDD的死亡率差异。结论：在感染控制项目中实施SDD可显著降低重症SARS-CoV-2感染患者的VAP和多重耐药菌感染发生率。
