COVID-19 患者呼吸机相关性肺炎：一项回顾性队列研究。
Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study.
机构信息
Division of Intensive Care, Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Türkiye.
Department of Infection Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Türkiye.
出版信息
Tuberk Toraks. 2023 Mar;71(1):41-47. doi: 10.5578/tt.20239906.
INTRODUCTION
We aimed to evaluate ventilator-associated pneumonia (VAP) incidence rate, risk factors, and isolated microorganisms in COVID-19 patients as the primary endpoint. Evaluation of VAP-associated intensive care unit (ICU) and hospital mortalities was the secondary endpoint.
MATERIALS AND METHODS
Records of patients admitted between March 2020- June 2021 to our pandemic ICU were reviewed and COVID-19 patients with VAP and non-VAP were evaluated retrospectively. Comorbidities, management, length of ICU stay, and outcomes of VAP and non-VAP patients, as well as risk factors for VAP mortality, were identified.
RESULT
During the study period, 254 patients were admitted to the ICU. After the exclusion, the data of 208 patients were reviewed. In total, 121 patients required invasive mechanical ventilation, with 78 (64.5%) developing VAP. Length of ICU and hospital stays were longer in VAP patients (p<0.01 and p<0.01 respectively). Steroid use was higher in VAP patients, although it was not statistically significant (p= 0.06). APACHE II score (p<0.01) was higher in non-VAP patients. ICU mortality was high in both groups (VAP 70%, non-VAP 77%). VAP mortality was higher in males (p= 0.03) and in patients who required renal replacement therapy (p= 0.01). Length of ICU stay (p= 0.04), and length of hospital stay (p<0.01) were both high in VAP survivors. The most common isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients and most of them were extensively drug-resistant.
CONCLUSIONS
Critically ill COVID-19 patients who required invasive mechanical ventilation developed VAP frequently. The length of ICU stay was longer in patients who developed VAP and ICU mortality was high in both VAP and non-VAP patients. The length of hospital and ICU stays among VAP survivors were also considerably high which is probably related to the long recovery period of COVID-19. The most frequently isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients.
简介
我们旨在评估 COVID-19 患者呼吸机相关性肺炎（VAP）的发生率、危险因素和分离的微生物，这是主要终点。评估 VAP 相关重症监护病房（ICU）和医院死亡率是次要终点。
材料和方法
回顾分析 2020 年 3 月至 2021 年 6 月间入住我院大流行 ICU 的患者记录，回顾性评估 VAP 和非 VAP 的 COVID-19 患者。确定 VAP 和非 VAP 患者的合并症、管理、ICU 住院时间和结局，以及 VAP 死亡率的危险因素。
结果
在研究期间，254 名患者入住 ICU。排除后，回顾了 208 名患者的数据。共有 121 名患者需要有创机械通气，其中 78 名（64.5%）发生 VAP。VAP 患者的 ICU 和住院时间更长（p<0.01 和 p<0.01）。VAP 患者使用类固醇的比例较高，但无统计学意义（p=0.06）。非 VAP 患者的 APACHE II 评分较高（p<0.01）。两组 ICU 死亡率均较高（VAP 70%，非 VAP 77%）。VAP 死亡率在男性中较高（p=0.03），在需要肾脏替代治疗的患者中较高（p=0.01）。VAP 幸存者的 ICU 住院时间（p=0.04）和住院时间（p<0.01）均较长。VAP 患者最常见的分离微生物是不动杆菌属和肺炎克雷伯菌属，大多数是广泛耐药的。
结论
需要有创机械通气的危重症 COVID-19 患者经常发生 VAP。发生 VAP 的患者 ICU 住院时间较长，VAP 和非 VAP 患者的 ICU 死亡率均较高。VAP 幸存者的 ICU 住院时间和住院时间也相当长，这可能与 COVID-19 的恢复时间较长有关。VAP 患者最常见的分离微生物是不动杆菌属和肺炎克雷伯菌属。
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