一家三级医院 COVID-19 重症监护病房患者血流感染的相关风险因素和临床结果。

IF 1 Q4 INFECTIOUS DISEASES
Journal of Global Infectious Diseases Pub Date : 2024-06-26 eCollection Date: 2024-04-01 DOI:10.4103/jgid.jgid_108_23
Mahalakshmamma Dasarahalli Shivalingappa, Supriya Gachinmath, Shiva Kumar Narayan
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引用次数: 0

摘要

导言:COVID-19 感染是一个持续存在的公共卫生危机,导致全球数百万人死亡。入住重症监护病房(ICU)的 COVID-19 患者更容易继发血流感染(sBSIs),从而导致严重的发病率和死亡率。因此,我们旨在评估 COVID-19 ICU 患者发生 sBSIs 的风险因素和结果:方法:收集 100 份有生长的血培养样本(病例)和 100 份无生长的血培养样本(对照)。对所有人口统计学数据、实验室数据和抗菌药耐药性模式进行了分析。微生物实验室收到的血培养瓶被装入自动血培养系统。通过 MALDI TOF 和自动抗生素药敏试验对标记瓶进行最终鉴定。通过 MALDI TOF 和自动抗生素药敏试验对标记瓶进行最终鉴定:结果:C反应蛋白(CRP)升高(P = 0.0035)、白细胞介素-6升高(P = 0.0404)、机械通气(MV)升高(P = 0.024)、既往抗菌药物暴露(P = 0.002)、ICU住院时间延长(中位 11 天)(P = 0.022)和死亡率升高(P = 0.001)与 BSI 显著相关。相当一部分 BSI 为革兰氏阴性菌(n = 115),如鲍曼不动杆菌 38 例(33%)和肺炎克雷伯菌 30 例(26%)。在我们的研究中,血液中单微生物的比例较高,为 72 (72%)。对头孢他啶29(96.6%)、阿米卡星48(96%)、美罗培南48(96%)、头孢他啶47(94%)、环丙沙星46(92%)和奈替米星46(92%)的耐药性最高(50)。肺炎双球菌对头孢他啶 29(96.6%)、头孢唑肟 29(96.6%)、环丙沙星 22(73.3%)和头孢呋辛 21(70%)高度耐药。在革兰氏阳性菌中,肠球菌对庆大霉素和青霉素的耐药率为 66.6%:结论:CRP 升高、需要使用 MV、之前接触过抗菌药物以及在重症监护室停留时间较长都应引起临床医生对 BSI 的警惕。因此,我们的研究强调了 BSI 的相关风险因素,并强调要遵守医院感染控制政策和抗生素管理计划。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Associated Risk Factors and Clinical Outcomes of Bloodstream Infections among COVID-19 Intensive Care Unit Patients in a Tertiary Care Hospital.

Introduction: The COVID-19 infection is an ongoing public health crisis causing millions of deaths worldwide. COVID-19 patients admitted to the intensive care unit (ICU) are more vulnerable to acquire secondary bloodstream infections (sBSIs) which cause a significant morbidity and mortality. Thus, we aim to assess the risk factors of sBSIs and outcomes in COVID-19 ICU patients.

Methods: One hundred blood culture samples with growth (cases) and other 100 blood culture with no growth(controls) were collected.. All the demographic data, laboratory data and antimicrobial resistance pattern were analysed . Blood culture bottle received in the Microbiology laboratory were loaded into Automated blood culture system. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing. Flagged bottles were processed for final identification by MALDI TOF and automated antibiotic susceptibility testing.

Results: Raised C-reactive protein (CRP) (P = 0.0035), interleukin-6 (P = 0.0404), mechanical ventilation (MV) (P = 0.024), prior antimicrobial exposure (P = 0.002), longer ICU stay with median 11 days (P = 0.022), and higher mortality rate (P = 0.001) were significantly associated with the BSI. A significant proportion of BSIs were Gram-negative bacteria (n = 115) such as Acinetobacter baumannii 38 (33%) and Klebsiella pneumoniae 30 (26%). Monomicrobial organisms in blood yielded a higher proportion in our study 72 (72%). The highest resistance for Acinetobacter species (50) was observed with ceftazidime 29 (96.6%) amikacin 48 (96%), meropenem 48 (96%), cefotaxime 47 (94%), ciprofloxacin 46 (92%), and netilmicin 46 (92%). K. pneumoniae was highly resistant to cefotaxime 29 (96.6%), ceftazidime 29 (96.6%), ciprofloxacin 22 (73.3%), and cefuroxime 21 (70%). Among Gram-positive organisms, Enterococcus species showed that a resistance for high-level gentamicin and penicillin was 66.6%.

Conclusions: Raised CRP, need of MV, prior antimicrobial exposure, and longer ICU stay should alarm clinicians for BSI. Hence, our study highlights the associated risk factors for BSI and emphasizes adherence to hospital infection control policies and antibiotic stewardship program.

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来源期刊
CiteScore
3.30
自引率
0.00%
发文量
31
审稿时长
29 weeks
期刊介绍: JGID encourages research, education and dissemination of knowledge in the field of Infectious Diseases across the world thus promoting translational research by striking a synergy between basic science, clinical medicine and public health. The Journal intends to bring together scientists and academicians in Infectious Diseases to promote translational synergy between Laboratory Science, Clinical Medicine and Public Health. The Journal invites Original Articles, Clinical Investigations, Epidemiological Analysis, Data Protocols, Case Reports, Clinical Photographs, review articles and special commentaries. Students, Residents, Academicians, Public Health experts and scientists are all encouraged to be a part of this initiative by contributing, reviewing and promoting scientific works and science.
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