Wu Guangjie, Lu Jianhua, Liu Dong, He Yan
Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Information, ZhuJiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
Antimicrob Steward Healthc Epidemiol. 2023 Sep 13;3(1):e156. doi: 10.1017/ash.2023.425. eCollection 2023.
To describe the characteristics and find out risk factors of COVID-19 patients infected with different categories of bacteria.
Case-control.
We conducted a retrospective study including 129 COVID-19 patients admitted to a tertiary hospital between October 13, 2022 and December 31, 2022. Patients' data were collected from the hospital information system. Patients were classified as having or not having confirmed secondary bacterial infections, or gram-positive and gram-negative bacterial infections for analysis. Categories and sources of isolated bacteria, characteristics of the patients, and the risk factors for developing secondary bacterial infections were analyzed.
Gram-negative bacteria accounted for the majority of secondary bacterial infections of the included patients. Critical type of COVID-19 (OR = 12.98, 95%CI 3.43∼49.18, < 0.001), invasive therapy (OR = 9.96, 95%CI 3.01∼32.95, < 0.001), and previous antibiotics use (OR = 17.23, 95%CI 1.38∼215.69, = 0.027) were independent risk factors of secondary bacterial infections in COVID-19 patients. Ceftriaxone/cefotaxime use (OR = 15.45, 95%CI 2.72∼87.79, = 0.002) was associated with gram-positive bacterial infections while age over 70 (OR = 3.30, 95%CI 1.06∼10.26, = 0.039), invasive therapy (OR = 4.68, 95%CI 1.22∼17.93, = 0.024), and carbapenems use (OR = 8.48, 95%CI 2.17∼33.15, = 0.002) were associated with gram-negative bacterial infections.
Critical patients with invasive therapy and previous antibiotics use should be cautious with secondary bacterial infections. Third-generation cephalosporins and carbapenems should be used carefully because both are risk factors for gram-positive or gram-negative bacterial infections.
描述新型冠状病毒肺炎（COVID-19）合并不同类别细菌感染患者的特征并找出危险因素。
病例对照研究。
我们进行了一项回顾性研究，纳入了2022年10月13日至2022年12月31日期间入住一家三级医院的129例COVID-19患者。患者数据从医院信息系统收集。患者被分类为有或没有确诊的继发性细菌感染，或革兰氏阳性和革兰氏阴性细菌感染以进行分析。分析分离细菌的类别和来源、患者特征以及发生继发性细菌感染的危险因素。
革兰氏阴性菌占纳入患者继发性细菌感染的大多数。COVID-19危重型（比值比[OR]=12.98，95%置信区间[CI]3.43～49.18，P<0.001）、侵入性治疗（OR=9.96，95%CI 3.01～32.95，P<0.001）和既往使用抗生素（OR=17.23，95%CI 1.38～215.69，P=0.027）是COVID-19患者继发性细菌感染的独立危险因素。使用头孢曲松/头孢噻肟（OR=15.45，95%CI 2.72～87.79，P=0.002）与革兰氏阳性菌感染相关，而70岁以上（OR=3.30，95%CI 1.06～10.26，P=0.039）、侵入性治疗（OR=4.68，95%CI 1.22～17.93，P=0.024）和使用碳青霉烯类（OR=8.48，95%CI 2.17～33.15，P=0.002）与革兰氏阴性菌感染相关。
接受侵入性治疗且既往使用过抗生素的危重症患者应警惕继发性细菌感染。应谨慎使用第三代头孢菌素和碳青霉烯类，因为两者都是革兰氏阳性或革兰氏阴性细菌感染的危险因素。
