Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Epidemiol Infect. 2023 Oct 10;151:e180. doi: 10.1017/S0950268823001644.
The aim of this study was to evaluate the impact of coronavirus disease 2019 (COVID-19) on treatment outcomes in critically ill patients with carbapenem-resistant (CRAB) bloodstream infection (BSI). This single-centre, retrospective cohort study was conducted in a 1,048-bed university-affiliated tertiary hospital in the Republic of Korea from January 2021 to March 2022. The study participants included consecutive hospitalised adult patients (aged ≥18 years) in the intensive care unit with CRAB monomicrobial BSI. During the study period, a total of 70 patients were included in our study, and 24 (34.3%) were diagnosed with COVID-19. The 28-day mortality rate was 64.3%. In the multivariate Cox proportional hazard regression analysis, diagnosis of COVID-19 (hazard ratio (HR), 2.91; 95% confidence interval (CI): 1.45-5.87), neutropenia (HR, 2.76; 95% CI: 1.04-7.29), Pitt bacteraemia score (per point; HR, 1.30; 95% CI: 1.19-1.41), and appropriate definite antibiotic therapy (HR, 0.31; 95% CI: 0.15-0.62) were independent predictors of 28-day mortality in patients with CRAB BSI. In conclusion, our findings suggested that COVID-19 has a negative prognostic impact on patients with CRAB BSI. Further study is needed to investigate the specific mechanisms of how COVID-19 worsens the prognosis of CRAB infection.
本研究旨在评估 2019 年冠状病毒病（COVID-19）对重症耐碳青霉烯肠杆菌科（CRAB）血流感染（BSI）患者治疗结局的影响。这项单中心、回顾性队列研究在韩国一家拥有 1048 张床位的大学附属医院进行，时间为 2021 年 1 月至 2022 年 3 月。研究对象包括入住重症监护病房的连续住院成年患者（年龄≥18 岁），其为 CRAB 单一微生物 BSI。在研究期间，共有 70 名患者纳入本研究，其中 24 名（34.3%）诊断为 COVID-19。28 天死亡率为 64.3%。在多变量 Cox 比例风险回归分析中，COVID-19 诊断（风险比（HR），2.91；95%置信区间（CI）：1.45-5.87）、中性粒细胞减少症（HR，2.76；95% CI：1.04-7.29）、Pitt 菌血症评分（每分；HR，1.30；95% CI：1.19-1.41）和适当的明确抗生素治疗（HR，0.31；95% CI：0.15-0.62）是 CRAB BSI 患者 28 天死亡率的独立预测因素。总之，我们的研究结果表明 COVID-19 对 CRAB BSI 患者的预后有负面影响。需要进一步研究以探讨 COVID-19 如何使 CRAB 感染的预后恶化的具体机制。
