Antoinette D. Reichert, Júlia M. da Silva Voorham, Karin H. Groenewegen, Huub La van den Oever
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引用次数: 0
摘要
背景:疱疹病毒科和曲霉菌属的肺部超级感染在 2019 年冠状病毒病(COVID-19)重症肺炎中很常见,但对其流行病学和影响仍知之甚少。研究方法我们对德文特医院重症监护室(2020-2021年)的61名因临床病情恶化而接受支气管肺泡灌洗(BL)的COVID-19机械通气患者进行了回顾性观察研究。我们对血液和呼吸道样本、治疗和临床结果进行了分析。结果在61名接受支气管肺泡灌洗的COVID-19机械通气患者中,34人(55.7%)患有超级感染,其中18人患有COVID-19相关肺曲霉菌病(CAPA),7人患有单纯疱疹病毒(HSV)感染,9人同时患有这两种感染。与 CAPA 患者相比,HSV 患者确诊时间更晚(中位数为 14 天 vs. 8 天,p = 0.014),机械通气时间更长(中位数为 47 天 vs. 18.5 天,p = 0.015),在重症监护室的时间更长(中位数为 74 天 vs. 24 天,p = 0.021)。基线时,实验室参数和治疗(地塞米松或托珠单抗)与超级感染无明显关联。各组死亡率无明显差异。结论在接受支气管肺泡灌洗的COVID-19机械通气患者中,HSV再激活发生在病程的后期,与CAPA相比,与机械通气和重症监护室停留时间延长有关。基线参数并不能预测超级感染。
Impact and Occurrence of Herpesvirus and Aspergillosis Superinfection in Patients with Severe COVID-19 Pneumonia
Background: Pulmonary superinfections with Herpesviridae and Aspergillus spp. are common in severe coronavirus disease 2019 (COVID-19) pneumonia but their epidemiology and impact remain poorly understood. Methods: We conducted a retrospective observational study of 61 mechanically ventilated COVID-19 patients at Deventer Hospital’s ICU (2020–2021) who underwent bronchoalveolar lavage (BL) due to clinical deterioration. We analyzed blood and respiratory samples, treatment, and clinical outcomes. Results: Among 61 mechanically ventilated COVID-19 patients who underwent BL, 34 (55.7%) had superinfections, with 18 having COVID-19-associated pulmonary aspergillosis (CAPA), 7 having herpes simplex virus (HSV) infection, and 9 having both. Patients with HSV had later diagnoses (median 14 vs. 8 days, p = 0.014), longer mechanical ventilation (median 47 vs. 18.5 days, p = 0.015), and longer ICU stays (median 74 vs. 24 days, p = 0.021) compared to CAPA patients. At baseline, laboratory parameters and treatment (dexamethasone or tocilizumab) showed no significant association with superinfections. Mortality did not differ significantly among groups. Conclusion: In mechanically ventilated COVID-19 patients undergoing bronchoalveolar lavage, HSV reactivation occurred later in the course of illness and was associated with longer mechanical ventilation and ICU stays compared to CAPA. Baseline parameters did not predict superinfections.