Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Family Health Research Institute. Maternal, Fetal, and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Eur J Med Res. 2023 Sep 2;28(1):314. doi: 10.1186/s40001-023-01303-3.
The emergence of healthcare-associated infections (HAIs) or superinfections in COVID-19 patients has resulted in poor prognosis and increased mortality.
In a cross-sectional study, 101 respiratory samples were collected from ICU-admitted COVID-19 patients. The HAI rate, demographics, and antibiotic resistance were assessed.
The HAI rate was 83.16% (76.62% bacterial and 6.54% fungal). The prevalence of 3 major HAI-causing organisms included Klebsiella pneumoniae (41.5%), Acinetobacter baumannii (20.8%), and Staphylococcus aureus (4.9%). Mortality and intubation ventilation proportions of 90% (p = 0.027) and 92.2% (p = 0.02) were significant among patients with superinfection, respectively. Multiple logistic regression analysis showed SpO pressure (odds ratio 0.842; 95% CI 0.750-0.945; p = 0.004) as a predictive factor in the association between antibiotic usage and mortality. More than 50% of patients received carbapenems. The resistance rates to at least one antibiotic of third-generation cephalosporins, aminoglycosides, quinolones/fluoroquinolones, tetracyclines, and β-lactam inhibitors were 95.2%, 95.2%, 90%, 57.1%, and 100% among A. baumannii isolates and 71.4%, 55%, 69%, 61.9%, and 59.5% among K. pneumoniae isolates, respectively. A proportion of 60% was recorded for methicillin-resistant S. aureus isolates.
As a result, antibiotic treatment should be administered following the microbial resistance profile. Contact isolation and infection control measures should be implemented as needed.
在 COVID-19 患者中出现了与医疗保健相关的感染（HAI）或再感染，导致预后不良和死亡率增加。
在一项横断面研究中，从 ICU 收治的 COVID-19 患者中采集了 101 份呼吸道样本。评估了 HAI 发生率、人口统计学特征和抗生素耐药性。
HAI 发生率为 83.16%（细菌 76.62%，真菌 6.54%）。三种主要 HAI 致病病原体的患病率包括肺炎克雷伯菌（41.5%）、鲍曼不动杆菌（20.8%）和金黄色葡萄球菌（4.9%）。超级感染患者的死亡率和插管通气比例分别为 90%（p=0.027）和 92.2%（p=0.02），差异有统计学意义。多因素 logistic 回归分析显示，SpO 压力（比值比 0.842；95%CI 0.750-0.945；p=0.004）是抗生素使用与死亡率之间关联的预测因素。超过 50%的患者接受了碳青霉烯类药物治疗。鲍曼不动杆菌分离株对第三代头孢菌素、氨基糖苷类、喹诺酮类/氟喹诺酮类、四环素类和β-内酰胺抑制剂至少一种抗生素的耐药率分别为 95.2%、95.2%、90%、57.1%和 100%，肺炎克雷伯菌分离株分别为 71.4%、55%、69%、61.9%和 59.5%。耐甲氧西林金黄色葡萄球菌分离株的比例为 60%。
因此，抗生素治疗应根据微生物耐药谱进行。应根据需要实施接触隔离和感染控制措施。
