[新型冠状病毒肺炎患者细菌性肺炎的病因]
[Etiology of bacterial pneumonias in patients with COVID-19].
作者信息
Angeles-Garay Ulises, Hernández-Herrera Joel Alejandro, Procopio-Velázquez Jorge, Alvarado-Yaah Julio Elías, González-Cruz Isaac Leopoldo
机构信息
Instituto Mexicano del Seguro Social, Centro Médico Nacional "La Raza", Hospital de Especialidades, División de Medicina Preventiva y Epidemiología Hospitalaria. Ciudad de México, México.
Instituto Mexicano del Seguro Social, Centro Médico Nacional "La Raza", Hospital de Especialidades, Departamento de Infectología. Ciudad de México, México.
出版信息
Rev Med Inst Mex Seguro Soc. 2022 Oct 25;60(6):632-639.
BACKGROUND
Aggregate bacterial pneumonia plays a fundamental role in mortality of patients hospitalized with COVID-19.
OBJECTIVE
To estimate the association of aggregated bacterial pneumonia with mortality in patients at Hospital Especialidades "La Raza".
MATERIAL AND METHODS
Analytical cross-sectional study, 252 COVID-19 patients, chest x-ray and culture of bronchial secretion or expectoration. Data taken from the SIOC electronic file and the IZASAlab platform.
RESULTS
252 participants, positive culture, 89 patients, 35.3%, isolation of K. pneumoniae (22.5%), A. baumannii (20.2%), P. aeruginosa (13.5%) and S. aureus (11.2%), antimicrobial resistance 37.1%. 43.7% died, lung damage greater than 50% RMa 2.25 (95% CI 1.01-5.11) p=0.04 against minor lung damage; microorganism in culture RMa 9.04 (95% CI 3.06-26.74) p=0.000; antimicrobial resistance RMa 7.57 (95% CI 1.34-42.79) p=0.02; S. aureus RMa 1.24 (95% CI 0.36-4.23) p=0.73; A. baumannii RMa 3.74 (95% CI 1.41-9.91) p=0.008; K. pneumoniae RMa 4.12 (95% CI 1.55-10.97) p=0.005; and P. aeruginosa RMa 6.89 (95% CI 1.62-17.61) p=0.01. Uncontrolled Diabetes RMa 1.61 (IC95% 1.1-2.9) p=0.018.
CONCLUSIONS
The development of added bacterial pneumonia increases the probability of death 2 times more, it amounts to 6 times more if there is antimicrobial resistance, it is observed to a greater extent for A. baumannii, K. pneumoniae and P. aeruginosa.
背景
聚集性细菌性肺炎在新冠肺炎住院患者的死亡率中起重要作用。
目的
评估“拉扎”专科医院中聚集性细菌性肺炎与患者死亡率之间的关联。
材料与方法
分析性横断面研究，纳入252例新冠肺炎患者，进行胸部X光检查及支气管分泌物或痰液培养。数据取自SIOC电子文件和IZASAlab平台。
结果
252名参与者，培养结果呈阳性，89例患者，占35.3%，分离出肺炎克雷伯菌（22.5%）、鲍曼不动杆菌（20.2%）、铜绿假单胞菌（13.5%）和金黄色葡萄球菌（11.2%），抗菌药物耐药率为37.1%。43.7%的患者死亡，肺部损伤大于50%时相对危险度为2.25（95%可信区间1.01 - 5.11），与轻度肺部损伤相比p = 0.04；培养出微生物时相对危险度为9.04（95%可信区间3.06 - 26.74），p = 0.000；抗菌药物耐药时相对危险度为7.57（95%可信区间1.34 - 42.79），p = 0.02；金黄色葡萄球菌相对危险度为1.24（95%可信区间0.36 - 4.23），p = 0.73；鲍曼不动杆菌相对危险度为3.74（95%可信区间1.41 - 9.91），p = 0.008；肺炎克雷伯菌相对危险度为4.12（95%可信区间1.55 - 10.97），p = 0.005；铜绿假单胞菌相对危险度为6.89（95%可信区间1.62 - 17.61），p = 0.01。未控制的糖尿病相对危险度为1.61（95%可信区间1.1 - 2.9），p = 0.018。
结论
合并细菌性肺炎的发生使死亡概率增加2倍以上，若存在抗菌药物耐药则增加至6倍以上，鲍曼不动杆菌、肺炎克雷伯菌和铜绿假单胞菌的情况更为明显。
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