COVID-19 和非 COVID-19 重症患者的耐多药病原体与呼吸机相关肺炎：一项前瞻性单中心观察比较研究

IF 4.7 2区医学 Q1 RESPIRATORY SYSTEM

Respiratory Research Pub Date : 2024-04-18 DOI:10.1186/s12931-024-02779-1

Giorgia Montrucchio, Eleonora Balzani, Gabriele Sales, Anna Vaninetti, Francesca Grillo, Anna Chiara Trompeo, Marinella Zanierato, Vito Fanelli, Silvia Corcione, Francesco Giuseppe De Rosa, Antonio Curtoni, Cristina Costa, Luca Brazzi

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引用次数: 0

摘要

COVID-19 大流行增加了重症患者中呼吸机相关肺炎（VAP）的发病率。然而，目前还缺乏对 COVID-19 和非 COVID-19 队列中 VAP 发生率的比较，尤其是在耐多药（MDR）菌高发的情况下。我们开展了一项单中心、前瞻性和回顾性混合队列研究，将 2020 年 3 月至 2021 年 12 月期间入住意大利都灵 "Città della Salute e della Scienza "大学医院重症监护室（ICU）的 COVID-19 患者（COVID-19 组）与 2016 年 6 月至 2018 年 3 月期间入住 ICU 的历史队列患者（NON-COVID-19 组）进行了比较。首要目标是确定两个队列中 VAP 的发生率。次要目标是评估微生物病因、耐药模式、风险因素及其对 28 天、ICU 和院内死亡率、ICU 留院时间和住院时间的影响）。我们发现，241 名 COVID-19 患者的 VAP 发生率（51.9% - n = 125）明显高于 252 名非 COVID-19 患者（31.2% - n = 78）。COVID-19 组患者的 SOFA 中位数得分明显较低（9，四分位数间距，IQR：7-11 vs. 10，IQR：8-13，p <0.001）。COVID-19 组的革兰氏阳性菌相关 VAP 感染率更高（30% vs. 9%，p < 0.001），但在难治性（DTR）或 MDR 细菌感染率方面未观察到显著差异。COVID-19 组和非 COVID-19 组的 ICU 和院内死亡率分别为 71% 和 74% 对 33% 和 43%。COVID-19的存在与28天全因住院死亡率风险的增加显著相关（危险比，HR：7.95，95% 置信区间，95% CI：3.10-20.36，p <0.001）。气管切开术和较短的机械通气时间可降低 28 天死亡率，而透析和 SOFA 评分较高则与较高的 28 天死亡率风险相关。无论是否存在 MDR 和 DTR 病原体，COVID-19 VAP 患者在重症监护室和院内的死亡风险似乎都明显较高。气管切开术和较短的机械通气时间似乎与较好的预后有关。

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Multidrug-resistant pathogens and ventilator-associated pneumonia in critically ill COVID-19 and non-COVID-19 patients: a prospective observational monocentric comparative study

The COVID-19 pandemic has increased the incidence of ventilator-associated pneumonia (VAP) among critically ill patients. However, a comparison of VAP incidence in COVID-19 and non-COVID-19 cohorts, particularly in a context with a high prevalence of multidrug-resistant (MDR) organisms, is lacking. We conducted a single-center, mixed prospective and retrospective cohort study comparing COVID-19 patients admitted to the intensive care unit (ICU) of the “Città della Salute e della Scienza” University Hospital in Turin, Italy, between March 2020 and December 2021 (COVID-19 group), with a historical cohort of ICU patients admitted between June 2016 and March 2018 (NON-COVID-19 group). The primary objective was to define the incidence of VAP in both cohorts. Secondary objectives were to evaluate the microbial cause, resistance patters, risk factors and impact on 28 days, ICU and in-hospital mortality, duration of ICU stay, and duration of hospitalization). We found a significantly higher incidence of VAP (51.9% - n = 125) among the 241 COVID-19 patients compared to that observed (31.2% - n = 78) among the 252 NON-COVID-19 patients. The median SOFA score was significantly lower in the COVID-19 group (9, Interquartile range, IQR: 7–11 vs. 10, IQR: 8–13, p < 0.001). The COVID-19 group had a higher prevalence of Gram-positive bacteria-related VAP (30% vs. 9%, p < 0.001), but no significant difference was observed in the prevalence of difficult-to-treat (DTR) or MDR bacteria. ICU and in-hospital mortality in the COVID-19 and NON-COVID-19 groups were 71% and 74%, vs. 33% and 43%, respectively. The presence of COVID-19 was significantly associated with an increased risk of 28-day all-cause hospital mortality (Hazard ratio, HR: 7.95, 95% Confidence Intervals, 95% CI: 3.10-20.36, p < 0.001). Tracheostomy and a shorter duration of mechanical ventilation were protective against 28-day mortality, while dialysis and a high SOFA score were associated with a higher risk of 28-day mortality. COVID-19 patients with VAP appear to have a significantly higher ICU and in-hospital mortality risk regardless of the presence of MDR and DTR pathogens. Tracheostomy and a shorter duration of mechanical ventilation appear to be associated with better outcomes.

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来源期刊

Respiratory Research 医学-呼吸系统

自引率

1.70%

发文量

314

期刊介绍： Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.