严重基础疾病医疗患者中 2019 冠状病毒病感染与 ICU 获得性念珠菌血症的关系：一项多中心前瞻性队列研究。

Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study.

机构信息

Service de Réanimation Polyvalente, Centre Hospitalier de Vannes, 56000, Vannes, France.

Service de Réanimation Polyvalente, Centre Hospitalier de Saint Brieuc, Saint-Brieuc, France.

出版信息

Crit Care. 2024 Sep 27;28(1):320. doi: 10.1186/s13054-024-05104-w.

DOI:10.1186/s13054-024-05104-w

PMID:39334254

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11429030/

Abstract

BACKGROUND

While SARS-CoV2 infection has been shown to be a significant risk-factor for several secondary bacterial, viral and Aspergillus infections, its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains poorly explored.

METHOD

Using the REA-REZO network (French surveillance network of ICU-acquired infections), we included all adult patients hospitalized for a medical reason of admission in participating ICUs for at least 48 h from January 2020 to January 2023. To account for confounders, a non-parsimonious propensity score matching was performed. Rates of ICAC according to SARS-CoV2 status were compared in matched patients. Factors associated with ICAC in COVID-19 patients were also assessed using a Fine-Gray model.

RESULTS

A total of 55,268 patients hospitalized at least 48 h for a medical reason in 101 ICUs were included along the study period. Of those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients developed an ICAC. ICAC rate was higher in COVID-19 patients in both the overall population and the matched patients' cohort (0.8% (107/13,472) versus 0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241) versus 0.5% (57/12,241); p = 0.004, respectively). ICAC incidence rate was also higher in those patients (incidence rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000 patients-days; incidence rate ratio: 1.58 [95% CI:1.08-2.35]; p = 0.018). Finally, patients with ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001).

CONCLUSION

In this large multicenter cohort of ICU patients, although remaining low, the rate of ICAC was higher among COVID-19 patients.

摘要

背景

虽然 SARS-CoV2 感染已被证明是几种继发性细菌、病毒和曲霉菌感染的重要危险因素，但它对重症监护病房（ICU）获得性念珠菌血症（ICAC）的影响仍未得到充分探索。

方法

使用 REA-REZO 网络（法国 ICU 获得性感染监测网络），我们纳入了 2020 年 1 月至 2023 年 1 月期间，因医疗原因在参与 ICU 住院至少 48 小时的所有成年患者。为了考虑混杂因素，进行了非简约倾向评分匹配。在匹配患者中比较了根据 SARS-CoV2 状态的 ICAC 发生率。还使用 Fine-Gray 模型评估了 COVID-19 患者中与 ICAC 相关的因素。

结果

在整个研究期间，共有 101 个 ICU 中因医疗原因住院至少 48 小时的 55268 名患者被纳入研究。其中，13472 名患者 SARS-CoV2 检测呈阳性，284 名患者发生 ICAC。在总体人群和匹配患者队列中，COVID-19 患者的 ICAC 发生率均较高（0.8%（107/13472）与 0.4%（173/41796）；p<0.001 和 0.8%（93/12241）与 0.5%（57/12241）；p=0.004，分别）。在这些患者中，ICAC 的发病率也更高（COVID-19 患者的发病率为每 1000 名患者-天 0.51 例，而每 1000 名患者-天 0.32 例；发病率比：1.58 [95%CI：1.08-2.35]；p=0.018）。最后，患有 ICAC 的患者 ICU 死亡率较高（49.6%与 20.2%；p<0.001）。