Shivalingappa Mahalakshmamma Dasarahalli, Gachinmath Supriya, Narayan Shiva Kumar
Department of Microbiology, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.
Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.
J Glob Infect Dis. 2024 Jun 26;16(2):60-67. doi: 10.4103/jgid.jgid_108_23. eCollection 2024 Apr-Jun.
The COVID-19 infection is an ongoing public health crisis causing millions of deaths worldwide. COVID-19 patients admitted to the intensive care unit (ICU) are more vulnerable to acquire secondary bloodstream infections (sBSIs) which cause a significant morbidity and mortality. Thus, we aim to assess the risk factors of sBSIs and outcomes in COVID-19 ICU patients.
One hundred blood culture samples with growth (cases) and other 100 blood culture with no growth(controls) were collected.. All the demographic data, laboratory data and antimicrobial resistance pattern were analysed . Blood culture bottle received in the Microbiology laboratory were loaded into Automated blood culture system. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing.
Raised C-reactive protein (CRP) ( = 0.0035), interleukin-6 ( = 0.0404), mechanical ventilation (MV) ( = 0.024), prior antimicrobial exposure ( = 0.002), longer ICU stay with median 11 days ( = 0.022), and higher mortality rate ( = 0.001) were significantly associated with the BSI. A significant proportion of BSIs were Gram-negative bacteria ( = 115) such as 38 (33%) and 30 (26%). Monomicrobial organisms in blood yielded a higher proportion in our study 72 (72%). The highest resistance for species (50) was observed with ceftazidime 29 (96.6%) amikacin 48 (96%), meropenem 48 (96%), cefotaxime 47 (94%), ciprofloxacin 46 (92%), and netilmicin 46 (92%). . was highly resistant to cefotaxime 29 (96.6%), ceftazidime 29 (96.6%), ciprofloxacin 22 (73.3%), and cefuroxime 21 (70%). Among Gram-positive organisms, species showed that a resistance for high-level gentamicin and penicillin was 66.6%.
Raised CRP, need of MV, prior antimicrobial exposure, and longer ICU stay should alarm clinicians for BSI. Hence, our study highlights the associated risk factors for BSI and emphasizes adherence to hospital infection control policies and antibiotic stewardship program.
新型冠状病毒肺炎（COVID-19）感染是一场持续的公共卫生危机，已在全球造成数百万人死亡。入住重症监护病房（ICU）的COVID-19患者更容易发生继发性血流感染（sBSIs），这会导致显著的发病率和死亡率。因此，我们旨在评估COVID-19 ICU患者发生sBSIs的危险因素及预后情况。
收集100份有细菌生长的血培养样本（病例组）和另外100份无细菌生长的血培养样本（对照组）。分析所有人口统计学数据、实验室数据及抗菌药物耐药模式。微生物实验室接收的血培养瓶被装入自动血培养系统。标记的培养瓶通过基质辅助激光解吸电离飞行时间质谱（MALDI TOF）进行最终鉴定并进行自动药敏试验。标记的培养瓶通过MALDI TOF进行最终鉴定并进行自动药敏试验。
C反应蛋白（CRP）升高（P = 0.0035）、白细胞介素-6升高（P = 0.0404）、机械通气（MV）（P = 0.024）、既往抗菌药物暴露（P = 0.002）、ICU住院时间较长（中位数为11天）（P = 0.022）以及较高的死亡率（P = 0.001）均与血流感染显著相关。相当一部分血流感染是革兰阴性菌（n = 115），如肺炎克雷伯菌38株（33%）和鲍曼不动杆菌30株（26%）。在我们的研究中，血液中的单一微生物占比更高，为72例（72%）。肺炎克雷伯菌对头孢他啶耐药率最高（50株中有29株，96.6%），对阿米卡星耐药率为48株（96%），对美罗培南耐药率为48株（96%），对头孢噻肟耐药率为47株（94%），对环丙沙星耐药率为46株（92%），对奈替米星耐药率为46株（92%）。鲍曼不动杆菌对头孢噻肟耐药率为29株（96.6%），对头孢他啶耐药率为29株（96.6%），对环丙沙星耐药率为22株（73.3%），对头孢呋辛耐药率为21株（70%）。在革兰阳性菌中，肠球菌属对高水平庆大霉素和青霉素的耐药率为66.6%。
CRP升高、需要机械通气、既往抗菌药物暴露以及ICU住院时间较长应提醒临床医生注意血流感染。因此，我们的研究突出了血流感染的相关危险因素，并强调要遵守医院感染控制政策和抗生素管理计划。
