COVID-19 Intensive Care Unit, Avicenna Military Hospital, Marrakech, Morocco.
Biosciences and Health Research Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco.
PLoS One. 2022 Dec 1;17(12):e0278175. doi: 10.1371/journal.pone.0278175. eCollection 2022.
There is a growing literature showing that critically ill COVID-19 patients have an increased risk of pulmonary co-infections and superinfections. However, studies in developing countries, especially African countries, are lacking. The objective was to describe the prevalence of bacterial co-infections and superinfections in critically ill adults with severe COVID-19 pneumonia in Morocco, the micro-organisms involved, and the impact of these infections on survival.
This retrospective study included severe COVID-19 patients admitted to the intensive care unit (ICU) between April 2020 and April 2021. The diagnosis of pulmonary co-infections and superinfections was based on the identification of pathogens from lower respiratory tract samples. Co-infection was defined as the identification of a respiratory pathogen, diagnosed concurrently with SARS-Cov2 pneumonia. Superinfections include hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). A multivariate regression analysis was performed to identify factors independently associated with mortality.
Data from 155 patients were analyzed. The median age was 68 years [62-72] with 87% of patients being male. A large proportion of patients (68%) received antibiotics before ICU admission. Regarding ventilatory management, the majority of patients (88%) underwent non-invasive ventilation (NIV). Sixty-five patients (42%) were placed under invasive mechanical ventilation, mostly after failure of NIV. The prevalence of co-infections, HAP and VAP was respectively 4%, 12% and 40% (64 VAP/1000 ventilation days). The most isolated pathogens were Enterobacterales for HAP and Acinetobacter sp. for VAP. The proportion of extra-drug resistant (XDR) bacteria was 78% for Acinetobacter sp. and 24% for Enterobacterales. Overall ICU mortality in this cohort was 64.5%. Patients with superinfection showed a higher risk of death (OR = 6.4, 95% CI: 1.8-22; p = 0.004).
In this single-ICU Moroccan COVID-19 cohort, bacterial co-infections were relatively uncommon. Conversely, high rates of superinfections were observed, with an increased frequency of antimicrobial resistance. Patients with superinfections showed a higher risk of death.
越来越多的文献表明，重症 COVID-19 患者发生肺部合并感染和继发感染的风险增加。然而，发展中国家，尤其是非洲国家的相关研究较少。本研究的目的是描述摩洛哥重症 COVID-19 肺炎患者中细菌合并感染和继发感染的流行情况、涉及的微生物以及这些感染对生存的影响。
本回顾性研究纳入 2020 年 4 月至 2021 年 4 月期间入住重症监护病房（ICU）的重症 COVID-19 患者。下呼吸道样本中病原体的鉴定是肺部合并感染和继发感染诊断的依据。合并感染定义为在 SARS-Cov2 肺炎的同时诊断出一种呼吸道病原体。继发感染包括医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）。采用多变量回归分析确定与死亡率独立相关的因素。
共分析了 155 例患者的数据。中位年龄为 68 岁[62-72]，87%的患者为男性。大多数患者（68%）在入住 ICU 前接受了抗生素治疗。在通气管理方面，大多数患者（88%）接受了无创通气（NIV）。65 例（42%）患者接受了有创机械通气，大多是在 NIV 失败后。合并感染、HAP 和 VAP 的发生率分别为 4%、12%和 40%（每 1000 个通气日发生 64 例 VAP）。HAP 最常分离出的病原体是肠杆菌科，VAP 最常分离出的病原体是不动杆菌属。耐多药（XDR）细菌的比例分别为不动杆菌属的 78%和肠杆菌科的 24%。该队列 ICU 死亡率为 64.5%。继发感染患者死亡风险更高（OR = 6.4，95%CI：1.8-22；p = 0.004）。
在本摩洛哥单 ICU COVID-19 队列中，细菌合并感染相对少见。相反，继发感染发生率较高，且抗菌药物耐药率较高。继发感染者死亡风险更高。
