重症监护病房中接受体外膜肺氧合治疗的新冠病毒疾病患者的血流感染：一项观察性队列研究。

Bloodstream infections in COVID-19 patients undergoing extracorporeal membrane oxygenation in ICU: An observational cohort study.

作者信息

Carelli Simone, Dell'Anna Antonio Maria, Montini Luca, Bernardi Giulia, Gozza Mariangela, Cutuli Salvatore Lucio, Natalini Daniele, Bongiovanni Filippo, Tanzarella Eloisa Sofia, Pintaudi Gabriele, Bocci Maria Grazia, Bisanti Alessandra, Bello Giuseppe, Grieco Domenico Luca, De Pascale Gennaro, Antonelli Massimo

机构信息

Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.

出版信息

Heart Lung. 2023 Nov-Dec;62:193-199. doi: 10.1016/j.hrtlng.2023.07.012. Epub 2023 Aug 8.

DOI:10.1016/j.hrtlng.2023.07.012

PMID:37562337

Abstract

BACKGROUND

COVID-19 patients undergoing ECMO are at highly increased risk of nosocomial infections.

OBJECTIVES

To study incidence, clinical outcomes and microbiological features of bloodstream infections (BSI) occurring during ECMO in COVID-19 patients.

METHODS

Observational prospective cohort study enrolling consecutive COVID-19 patients undergoing veno-venous-ECMO in an Italian ICU from March 2020 to March 2022.

RESULTS

In the study population of 68 patients (age 53 [49-60] years, 82% males), 30 (44%) developed bloodstream infections (BSI group) while 38 did not (N-BSI group) with an incidence of 32 events/1000 days of ECMO. In BSI group pre-ECMO respiratory support was shorter (6 [4-9] vs 9 [5-12] days, p = 0.02) and ECMO treatment was longer (18 [10-29] vs 11 [7-18] days, p = 0.03) than in N-BSI group. The overall ECMO and ICU mortality were 50% and 59%, respectively, without any inter-group difference (p = 1.00). A longer ECMO treatment was independently correlated with higher rate of BSI (p = 0.04, OR [95% CI] 1.06 [1.02-1.11]). Sixteen primary and 14 secondary infectious events were documented. Gram-positive pathogens were more common in primary than secondary BSI (88% vs 43%, p = 0.02) and Enterococcus faecalis (56%) was the most frequent one. Conversely, Gram-negative microorganisms were more often isolated in secondary rather than primary BSI (57% vs 13%, p = 0.02), with Acinetobacter baumannii (21%) and Pseudomonas aeruginosa (21%) as most represented species. The administration of Sars-CoV-2 antiviral drug showed independent correlation with a reduced rate of ICU mortality (p = 0.01, OR [95% CI] 0.22 [0.07-0.73]).

CONCLUSIONS

Bloodstream infections represented a frequent complication without worsening clinical outcomes in our COVID-19 patients undergoing ECMO. Primary and secondary BSI events showed peculiar microbiological profiles.

摘要

背景

接受体外膜肺氧合（ECMO）治疗的新型冠状病毒肺炎（COVID-19）患者发生医院感染的风险大幅增加。

目的

研究COVID-19患者在ECMO治疗期间发生血流感染（BSI）的发生率、临床结局和微生物学特征。

方法

2020年3月至2022年3月在意大利一家重症监护病房（ICU）对连续接受静脉-静脉ECMO治疗的COVID-19患者进行前瞻性观察队列研究。

结果

在68例研究对象（年龄53[49 - 60]岁，82%为男性）中，30例（44%）发生血流感染（BSI组），38例未发生（非BSI组），ECMO每1000天的BSI发生率为32次。与非BSI组相比，BSI组在ECMO治疗前的呼吸支持时间更短（6[4 - 9]天对9[5 - 12]天，p = 0.02），而ECMO治疗时间更长（18[10 - 29]天对11[7 - 18]天，p = 0.03）。总体ECMO和ICU死亡率分别为50%和59%，两组间无差异（p = 1.00）。较长的ECMO治疗时间与较高的BSI发生率独立相关（p = 0.04，比值比[95%置信区间]1.06[1.02 - 1.11]）。记录到16例原发性和14例继发性感染事件。革兰氏阳性病原体在原发性BSI中比继发性BSI更常见（88%对43%，p = 0.02），粪肠球菌（56%）是最常见的一种。相反，革兰氏阴性微生物在继发性BSI中比原发性BSI更常分离到（57%对13%，p = 0.02），鲍曼不动杆菌（21%）和铜绿假单胞菌（21%）是最具代表性的菌种。使用严重急性呼吸综合征冠状病毒2（Sars-CoV-2）抗病毒药物与降低ICU死亡率独立相关（p = 0.01，比值比[95%置信区间]0.22[0.07 - 0.73]）。