Paulina Dąbrowska, Mateusz Bartoszewicz, Klaudia Bartoszewicz, Juliusz Kosel, Samuel Stróż, Jerzy Robert Ładny, Sławomir Lech Czaban
{"title":"COVID-19重症患者导尿管相关尿路感染：一项回顾性队列研究。","authors":"Paulina Dąbrowska, Mateusz Bartoszewicz, Klaudia Bartoszewicz, Juliusz Kosel, Samuel Stróż, Jerzy Robert Ładny, Sławomir Lech Czaban","doi":"10.1177/20499361241278218","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19.</p><p><strong>Objective: </strong>The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19.</p><p><strong>Design: </strong>Single-center, retrospective cohort study.</p><p><strong>Methods: </strong>The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (<i>n</i> = 56) and non-CA-UTI (<i>n</i> = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI.</p><p><strong>Results: </strong>CA-UTIs developed in 28% of patients (<i>n</i> = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, <i>p</i> < 0.001) and more elevated mortality rates (75.0% vs 54.5%, <i>p</i> = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, <i>p</i> = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, <i>p</i> < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly <i>Klebsiella pneumoniae</i> (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%.</p><p><strong>Conclusion: </strong>The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.</p>","PeriodicalId":46154,"journal":{"name":"Therapeutic Advances in Infectious Disease","volume":"11 ","pages":"20499361241278218"},"PeriodicalIF":3.8000,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11452867/pdf/","citationCount":"0","resultStr":"{\"title\":\"Catheter-associated urinary tract infections in critically Ill patients with COVID-19: a retrospective cohort study.\",\"authors\":\"Paulina Dąbrowska, Mateusz Bartoszewicz, Klaudia Bartoszewicz, Juliusz Kosel, Samuel Stróż, Jerzy Robert Ładny, Sławomir Lech Czaban\",\"doi\":\"10.1177/20499361241278218\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19.</p><p><strong>Objective: </strong>The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19.</p><p><strong>Design: </strong>Single-center, retrospective cohort study.</p><p><strong>Methods: </strong>The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (<i>n</i> = 56) and non-CA-UTI (<i>n</i> = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI.</p><p><strong>Results: </strong>CA-UTIs developed in 28% of patients (<i>n</i> = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, <i>p</i> < 0.001) and more elevated mortality rates (75.0% vs 54.5%, <i>p</i> = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, <i>p</i> = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, <i>p</i> < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly <i>Klebsiella pneumoniae</i> (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%.</p><p><strong>Conclusion: </strong>The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. 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引用次数: 0
摘要
背景：导管相关性尿路感染（CA-UTI导尿管相关性尿路感染（CA-UTI）是重症监护病房（ICU）COVID-19患者面临的一项重大挑战：该研究旨在评估CAVID-19重症监护病房患者中CA-UTI的发病率，确定致病病原体及其耐药性特征，并确定与CA-UTI相关的风险因素和结果：设计：单中心、回顾性队列研究：研究纳入了2020年3月至2021年7月期间确诊为COVID-19的201名成人ICU患者。患者被分为CA-UTI组（56人）和非CA-UTI组（145人）。收集了有关人口统计学特征、临床过程、治疗和结果的数据。采用逻辑回归分析确定CA-UTI的风险因素：结果：28%的患者（n = 56）发生了 CA-UTI。发病密度为每 1000 个导管日 15.8 例。平均发病时间为入院后 7.2 天。CA-UTI 患者在 ICU 的住院时间较长（18.8 天 vs 10.5 天，p p = 0.010），机械通气（MV）使用率较高（98.2% vs 88.3%，p = 0.027），MV 平均持续时间较长（16.6 天 vs 9.1 天，p p 肺炎克雷伯菌（28 例）是最常见的病原体，耐多药（38.8%）率较高，耐药类型有 ESBL、MBL、NDM 和 OXA-48。耐多药（MDR）生物的发生率为 68.8%：结论：本研究结果强调了COVID-19在ICU患者中的CA-UTI发病率，对患者的预后产生了重大影响。有效的感染控制和有针对性的抗菌治疗对控制这些感染至关重要。
Catheter-associated urinary tract infections in critically Ill patients with COVID-19: a retrospective cohort study.
Background: Catheter-associated urinary tract infections (CA-UTIs) pose a significant challenge in intensive care unit (ICU) patients with COVID-19.
Objective: The study aims to assess the prevalence of CA-UTIs, identify the causative pathogens and their resistance profiles, and determine the risk factors and outcomes associated with CA-UTIs in ICU patients with COVID-19.
Methods: The study included 201 adult ICU patients diagnosed with COVID-19 between March 2020 and July 2021. Patients were categorized into CA-UTI (n = 56) and non-CA-UTI (n = 145) groups. Data on demographic characteristics, clinical course, treatment, and outcomes were collected. Logistic regression analysis was used to identify risk factors for CA-UTI.
Results: CA-UTIs developed in 28% of patients (n = 56). Incidence density of 15.8 episodes per 1000 catheter days. The average onset occurrence is 7.2 days after ICU admission. Patients with CA-UTI had longer ICU stays (18.8 days vs 10.5 days, p < 0.001) and more elevated mortality rates (75.0% vs 54.5%, p = 0.010), higher mechanical ventilation (MV) usage (98.2% vs 88.3%, p = 0.027), a longer average duration of MV (16.6 days vs 9.1 days, p < 0.001). Longer ICU and hospital stays were significant risk factors for CA-UTI. Other factors, such as the use of corticosteroids, chronic organ insufficiency or immunocompromized status, female sex, age, diabetes mellitus, and the duration of urinary catheterization, did not show significant associations with CA-UTI risk in this cohort. Gram-negative bacteria, particularly Klebsiella pneumoniae (28 cases), was the most common pathogen, with a high prevalence of multidrug resistance (38.8%) with type ESBL, MBL, NDM, and OXA-48. The occurrence of multidrug resistant (MDR) organisms was 68.8%.
Conclusion: The findings of this study underscore the prevalence of CA-UTIs in ICU patients with COVID-19, significantly impacting patient outcomes. Effective infection control and targeted antimicrobial therapy are crucial to managing these infections.
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