COVID-19 相关 ARDS 危重症患者 ICU 中的继发感染：频率、微生物学特征和危险因素。

Secondary Infections in Critical Patients with COVID-19 Associated ARDS in the ICU: Frequency, Microbiologic Characteristics and Risk Factors.

机构信息

Clinic of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey.

Department of Pulmonary Diseases, COVID Intensive Care Unit, University of Health Sciences, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, Turkey.

出版信息

J Coll Physicians Surg Pak. 2023 Feb;33(2):181-187. doi: 10.29271/jcpsp.2023.02.181.

DOI:10.29271/jcpsp.2023.02.181

PMID:36797628

Abstract

OBJECTIVE

To determine frequency, microbiologic characteristics and risks of secondary infections in patients with Coronavirus disease 2019 (COVID-19) associated acute respiratory distress syndrome (ARDS).

STUDY DESIGN

An Observational study.

PLACE AND DURATION OF STUDY

COVID-19 intensive care unit (ICU), University of Health Sciences, Diskapı Yildirim Beyazit Research and Training Hospital, Turkey, from July 2020 to January 2021.

METHODOLOGY

Demographic data of the COVID-19 patients with ARDS, was collected with reference to (age, gender), comorbidities, illness scores, ICU management modalities, hospital, and ICU stay durations and ICU outcomes. Secondary infections [bloodstream infection (BSI), possible lower respiratory tract infection (pLRTI) or urinary tract infections (UTI)], microbiologic pathogens, and resistant patterns were recorded.

RESULTS

A total of 205 COVID-19-related ARDS patients were included in this study. Out of them, 61 (29.8%) were diagnosed with secondary infection, 27 (13.1%) had at least one BSI, 20 (9.8%) had at least one pLRTI, and 34 (16.6%) had at least one UTI. Gram-negative pathogens were the most common cause of secondary infections (66/91, 72.5%). Klebsiella spp for BSI (10/19, 52.6%), Acinetobacter baumannii for pLRTI (10/18, 55.6%), and Escherichia coli for UTI (29/40, 72.5%) were the main causative agents. Among all Gram-negative bacteria, Carbapenem resistant was 62.1% (41/66) and extended-spectrum beta-lactamases positivity was 22.7% (15/66). At multivariable analysis, application of mechanical ventilation (MV) longer than 48 h, central catheterisation longer than 72 h, ICU stay longer than 10 days, and the time from hospitalisation to admission to the ICU longer than 48 h were associated with secondary infections.

CONCLUSION

Patients with COVID-19 associated ARDS had a high rate of secondary infections. In order to reduce secondary infection in these patients, MV duration and ICU stay should be shortened and invasive catheters should be removed as soon as possible.

KEY WORDS

SARS-CoV-2, COVID-19, Acute respiratory distress syndrome, Secondary infections.

摘要

目的

确定与 2019 年冠状病毒病（COVID-19）相关的急性呼吸窘迫综合征（ARDS）患者继发性感染的频率、微生物学特征和风险。

研究设计

观察性研究。

地点和研究时间

土耳其健康科学大学 Diskapı Yildirim Beyazit 研究与培训医院的 COVID-19 重症监护病房（ICU），2020 年 7 月至 2021 年 1 月。

方法

收集 COVID-19 合并 ARDS 患者的人口统计学数据，参考（年龄、性别）、合并症、疾病评分、ICU 管理方式、住院时间、ICU 入住时间和 ICU 结果。记录继发性感染[血流感染（BSI）、可能的下呼吸道感染（pLRTI）或尿路感染（UTI）]、微生物病原体和耐药模式。

结果

本研究共纳入 205 例 COVID-19 相关 ARDS 患者。其中，61 例（29.8%）诊断为继发性感染，27 例（13.1%）至少有一次 BSI，20 例（9.8%）至少有一次 pLRTI，34 例（16.6%）至少有一次 UTI。革兰氏阴性病原体是继发性感染的最常见原因（66/91，72.5%）。BSI 的主要病原体为克雷伯菌属（10/19，52.6%），pLRTI 的主要病原体为鲍曼不动杆菌（10/18，55.6%），UTI 的主要病原体为大肠埃希菌（29/40，72.5%）。所有革兰氏阴性菌中，碳青霉烯类耐药率为 62.1%（41/66），超广谱β-内酰胺酶阳性率为 22.7%（15/66）。多变量分析显示，机械通气（MV）时间超过 48 小时、中央导管留置时间超过 72 小时、ICU 入住时间超过 10 天以及从住院到入住 ICU 的时间超过 48 小时与继发性感染有关。