Crit Care:入住ICU的COVID-19患者合并感染和ICU获得性感染的情况

2022-08-06 MedSci原创 MedSci原创

在重症COVID-19患者中,ICU入院时合并感染相对少见,但抗生素的使用大大超过了这一指征。ICU-AI很常见,且与皮质激素的使用显著相关。

COVID-19大流行给全球危重病治疗机构带来了重大挑战。在COVID-19散发和大流行情况下,伴随病毒性肺炎发生或随后发生的感染对患者是一种挑战;然而,数据表明COVID-19和其他病毒性肺炎不同。

近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,该研究通过二次分析旨在探索在一个大型的国际COVID-19危重患者队列中合并感染和重症监护室获得性感染(ICU-AI)的模式,以及与皮质激素使用之间的关系。

这是一项多中心、国际性的观察性研究,纳入了在第一波COVID-19高峰(2020年2月15日至5月15日),经PCR确诊的且入住ICU的COVID-19成年患者。研究人员收集的数据包括ICU住院时合并感染、ICU获得性感染、多重耐药微生物感染(MDRO)和抗生素使用情况。研究人员采用Pearson卡方法对频率进行了比较,而连续变量采用Mann-WhitneyU检验进行分析。研究人员使用R库MatchIT采用“完全”匹配方法对ICU获得性感染相关变量进行了倾向评分匹配。

该研究的数据来自4994名患者。716例患者(14%)在入院时发现细菌合并感染,而85%的患者在该阶段接受了抗生素治疗。2715例(54%)患者发展为ICU-AI。最常见的ICU-AI是细菌性肺炎(44%的感染),而9%的患者发展为真菌性肺炎;25%的感染与MDRO有关。ICU发生感染的患者比未发生此类感染的患者抗菌暴露几率更大。ICU期间使用皮质类固醇具有异质性。在单因素分析中,58%接受皮质类固醇治疗的患者和43%未接受类固醇治疗的患者发生ICU-AI。在调整倾向匹配队列中的潜在混杂因素后,接受皮质类固醇激素的患者中71%发生ICU-AI,未接受皮质类固醇激素的患者中有52%发生ICU-AI。皮质类固醇治疗的持续时间也与ICU-AI和MDRO感染的发生有关。

由此可见,在重症COVID-19患者中,ICU入院时合并感染相对少见,但抗生素的使用大大超过了这一指征。ICU-AI很常见,且与皮质激素的使用显著相关。

原始出处:

Andrew Conway Morris.et al.Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set.Critical Care.2022.https://ccforum.biomedcentral.com/articles/10.1186/s13054-022-04108-8

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  3. [GetPortalCommentsPageByObjectIdResponse(id=2042701, encodeId=3c8a2042e016a, content=<a href='/topic/show?id=999c88014ea' target=_blank style='color:#2F92EE;'>#获得性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88014, encryptionId=999c88014ea, topicName=获得性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 17 08:29:27 CST 2023, time=2023-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297595, encodeId=435f129e5957d, content=<a href='/topic/show?id=c0385134ab' target=_blank style='color:#2F92EE;'>#COVID-19患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5134, encryptionId=c0385134ab, topicName=COVID-19患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6976269, createdName=zhangph, createdTime=Mon Aug 08 09:29:27 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237043, encodeId=689d123e0434f, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sun Aug 07 09:46:58 CST 2022, time=2022-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237026, encodeId=fd60123e02605, content=看了, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d82d5509267, createdName=ms4000001617073333, createdTime=Sun Aug 07 08:26:47 CST 2022, time=2022-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237007, encodeId=d6bf123e00749, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=47345488268, createdName=guoyin0901, createdTime=Sun Aug 07 00:06:23 CST 2022, time=2022-08-07, status=1, ipAttribution=)]
    2022-08-07 xulv123

    认真学习~~

    0

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    2022-08-07 ms4000001617073333

    看了

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2042701, encodeId=3c8a2042e016a, content=<a href='/topic/show?id=999c88014ea' target=_blank style='color:#2F92EE;'>#获得性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88014, encryptionId=999c88014ea, topicName=获得性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d4b7363, createdName=pandamao2010, createdTime=Mon Apr 17 08:29:27 CST 2023, time=2023-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1297595, encodeId=435f129e5957d, content=<a href='/topic/show?id=c0385134ab' target=_blank style='color:#2F92EE;'>#COVID-19患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5134, encryptionId=c0385134ab, topicName=COVID-19患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6976269, createdName=zhangph, createdTime=Mon Aug 08 09:29:27 CST 2022, time=2022-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237043, encodeId=689d123e0434f, content=认真学习~~, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfb41991958, createdName=xulv123, createdTime=Sun Aug 07 09:46:58 CST 2022, time=2022-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237026, encodeId=fd60123e02605, content=看了, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d82d5509267, createdName=ms4000001617073333, createdTime=Sun Aug 07 08:26:47 CST 2022, time=2022-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1237007, encodeId=d6bf123e00749, content=好, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=47345488268, createdName=guoyin0901, createdTime=Sun Aug 07 00:06:23 CST 2022, time=2022-08-07, status=1, ipAttribution=)]
    2022-08-07 guoyin0901

    0

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