重症监护病房中医护相关感染的危险因素及其与新冠疫情各波次的关系：一项巢式病例对照研究
Risk factors for healthcare-associated infections and their relationship with waves of the COVID-19 pandemic in an intensive care unit: a nested case-control study.
作者信息
Menezes Fernando Gatti de, Corrêa Thiago Domingos, Bravim Bruno de Arruda, Tuma Paula, Silva Júnior Moacyr, Gouveia Emy Akiyama, Toniolo Alexandra do Rosário, Paiva Graziela Geanfrancisco Matta de, Martineli Paula Fernanda, Castagna Helena Maria Fernandes, Moraes Talita Silva Sarro, Santiago Ana Carolina, Gonçalves Priscila, Pereira Brunna Oliveira, Gonçalves Nathalia Thomazi, Malheiro Daniel Tavares, Teich Vanessa Damazio, Cendoroglo Neto Miguel
机构信息
Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
出版信息
Einstein (Sao Paulo). 2024 Dec 16;22:eAO0939. doi: 10.31744/einstein_journal/2024AO0939. eCollection 2024.
OBJECTIVE
To evaluate the risk factors for healthcare-related infections during the COVID-19 pandemic in intensive care units, to investigate the impact of COVID-19 on Central Line-Associated Bloodstream Infection, Catheter-Associated Urinary Tract Infection, and ventilator-associated pneumonia, and to describe healthcare-associated infections in the waves of the COVID-19 pandemic.
METHODS
This nested case-control study was conducted in a 137-bed adult medical/surgical intensive care unit at a private hospital in São Paulo, Brazil, between January 11, 2019, and May 21, 2022. Case patients were identified using the Nosocomial Infection Control Committee database and control patients were identified using the intensive care unit's EPIMED system. For the analysis of risk factors, the chi-square test, multiple logistic regression model, and Kaplan-Meier method were used to identify independent risk factors, considering p<0.05.
RESULTS
The Case Group consisted of 189 healthcare-associated infections, including ventilator-associated pneumonia (61.4%), Central Line-Associated Bloodstream Infection (30.1%), Catheter-Associated Urinary Tract Infection (8.5%), and the Control Group consisted of 6,834 patients. The independent risk factors were COVID-19 infection (OR=2.84, 95%CI=1.92-4.23, p<0.01), length of stay in intensive care greater than 14 days (OR=3.15, 95%CI=1.95-5.14, p<0.01), length of hospital stay greater than 30 days (OR=3.64, 95%CI=2.44-5.51, p<0.01), and patients who were in the third wave (OR=1.72, 95%CI=1.05-2.91, p=0.04). Ventilator-associated pneumonia was the only healthcare-related infection for which COVID-19 infection was an independent risk factor (OR=3.32, 95%CI=1.92-5.94, p<0.01).
CONCLUSION
COVID-19 and length of hospital stay were independent risk factors for healthcare-associated infections, and only ventilator-associated pneumonia was affected by the COVID-19 pandemic.
目的
评估重症监护病房在新冠疫情期间与医疗保健相关感染的风险因素，调查新冠疫情对中心静脉导管相关血流感染、导尿管相关尿路感染及呼吸机相关性肺炎的影响，并描述新冠疫情各波次中的医疗保健相关感染情况。
方法
这项巢式病例对照研究于2019年1月11日至2022年5月21日在巴西圣保罗一家私立医院的137张床位的成人内科/外科重症监护病房进行。病例患者通过医院感染控制委员会数据库识别，对照患者通过重症监护病房的EPIMED系统识别。对于风险因素分析，采用卡方检验、多重逻辑回归模型和Kaplan-Meier方法来识别独立风险因素，以p<0.05为标准。
结果
病例组包括189例与医疗保健相关的感染，其中呼吸机相关性肺炎（61.4%）、中心静脉导管相关血流感染（30.1%）、导尿管相关尿路感染（8.5%），对照组包括6834例患者。独立风险因素为新冠感染（OR=2.84，95%CI=1.92-4.23，p<0.01）、重症监护病房住院时间超过14天（OR=3.15，95%CI=1.95-5.14，p<0.01）、住院时间超过30天（OR=3.64，95%CI=2.44-5.51，p<0.01）以及处于第三波疫情中的患者（OR=1.72，95%CI=1.05-2.91，p=0.04）。呼吸机相关性肺炎是唯一一种新冠感染为独立风险因素的医疗保健相关感染（OR=3.32，95%CI=1.92-5.94，p<0.01）。
结论
新冠感染和住院时间是与医疗保健相关感染的独立风险因素，且只有呼吸机相关性肺炎受到新冠疫情的影响。
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