Montrucchio Giorgia, Corcione Silvia, Lupia Tommaso, Shbaklo Nour, Olivieri Carlo, Poggioli Miriam, Pagni Aline, Colombo Davide, Roasio Agostino, Bosso Stefano, Racca Fabrizio, Bonato Valeria, Della Corte Francesco, Guido Stefania, Della Selva Andrea, Ravera Enrico, Barzaghi Nicoletta, Cerrano Martina, Caironi Pietro, Berta Giacomo, Casalini Cecilia, Scapino Bruno, Grio Michele, Parlanti Garbero Massimiliano, Buono Gabriella, Finessi Federico, Erbetta Simona, Sciacca Paola Federica, Fiore Gilberto, Cerutti Alessandro, Livigni Sergio, Silengo Daniela, Agostini Fulvio, Berardino Maurizio, Navarra Mauro, Vendramin Silvia, Castenetto Enzo, Liccardi Marco Maria, Manno Emilpaolo, Brazzi Luca, De Rosa Francesco Giuseppe
Department of Surgical Sciences, University of Turin, 10126 Turin, Italy.
Department of Anaesthesia, Critical Care and Emergency-Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, 10126 Turin, Italy.
J Clin Med. 2022 Sep 2;11(17):5208. doi: 10.3390/jcm11175208.
Since the beginning of the COVID-19 pandemic, the impact of superinfections in intensive care units (ICUs) has progressively increased, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab). This observational, multicenter, retrospective study was designed to investigate the characteristics of COVID-19 ICU patients developing CR-Ab colonization/infection during an ICU stay and evaluate mortality risk factors in a regional ICU network. A total of 913 COVID-19 patients were admitted to the participating ICUs; 19% became positive for CR-Ab, either colonization or infection (n = 176). The ICU mortality rate in CR-Ab patients was 64.7%. On average, patients developed colonization or infection within 10 ± 8.4 days from ICU admission. Scores of SAPS II and SOFA were significantly higher in the deceased patients (43.8 ± 13.5, p = 0.006 and 9.5 ± 3.6, p < 0.001, respectively). The mortality rate was significantly higher in patients with extracorporeal membrane oxygenation (12; 7%, p = 0.03), septic shock (61; 35%, p < 0.001), and in elders (66 ± 10, p < 0.001). Among the 176 patients, 129 (73%) had invasive infection with CR-Ab: 105 (60.7%) Ventilator-Associated Pneumonia (VAP), and 46 (26.6%) Bloodstream Infections (BSIs). In 22 cases (6.5%), VAP was associated with concomitant BSI. Colonization was reported in 165 patients (93.7%). Mortality was significantly higher in patients with VAP (p = 0.009). Colonized patients who did not develop invasive infections had a higher survival rate (p < 0.001). Being colonized by CR-Ab was associated with a higher risk of developing invasive infections (p < 0.001). In a multivariate analysis, risk factors significantly associated with mortality were age (OR = 1.070; 95% CI (1.028−1.115) p = 0.001) and CR-Ab colonization (OR = 5.463 IC95% 1.572−18.988, p = 0.008). Constant infection-control measures are necessary to stop the spread of A. baumannii in the hospital environment, especially at this time of the SARS-CoV-2 pandemic, with active surveillance cultures and the efficient performance of a multidisciplinary team.
自新冠疫情开始以来，重症监护病房（ICU）中多重感染的影响日益增加，尤其是耐碳青霉烯鲍曼不动杆菌（CR-Ab）。这项观察性、多中心、回顾性研究旨在调查在ICU住院期间发生CR-Ab定植/感染的新冠ICU患者的特征，并评估区域ICU网络中的死亡风险因素。共有913名新冠患者入住参与研究的ICU；19%的患者CR-Ab呈阳性，包括定植或感染（n = 176）。CR-Ab患者的ICU死亡率为64.7%。平均而言，患者在入住ICU后10±8.4天内发生定植或感染。死亡患者的序贯器官衰竭评估（SOFA）评分和简化急性生理学评分（SAPS II）显著更高（分别为43.8±13.5，p = 0.006和9.5±3.6，p < 0.001）。接受体外膜肺氧合的患者死亡率显著更高（12例；7%，p = 0.03），感染性休克患者死亡率显著更高（61例；35%，p < 0.001），老年患者死亡率显著更高（66±10，p < 0.001）。在这176例患者中，129例（73%）发生CR-Ab侵袭性感染：105例（60.7%）为呼吸机相关性肺炎（VAP），46例（26.6%）为血流感染（BSI）。22例（6.5%）患者的VAP合并BSI。165例患者（93.7%）报告有定植。VAP患者的死亡率显著更高（p = 0.009）。未发生侵袭性感染的定植患者生存率更高（p < 0.001）。被CR-Ab定植与发生侵袭性感染的风险更高相关（p < 0.001）。多因素分析显示，与死亡率显著相关的风险因素为年龄（比值比[OR] = 1.070；95%置信区间[CI]为1.028−1.115，p = 0.001）和CR-Ab定植（OR = 5.463，95%CI为1.572−18.988，p = 0.008）。必须持续采取感染控制措施，以阻止鲍曼不动杆菌在医院环境中的传播，尤其是在新冠疫情期间，通过主动监测培养以及多学科团队的高效协作来实现。
