Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors.
Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors.
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DOI：
10.1016/j.cmi.2020.10.021
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
COVID-BioB study group
中科院分区：
文献类型：
--
作者：
Ripa M;Galli L;Poli A;Oltolini C;Spagnuolo V;Mastrangelo A;Muccini C;Monti G;De Luca G;Landoni G;Dagna L;Clementi M;Rovere Querini P;Ciceri F;Tresoldi M;Lazzarin A;Zangrillo A;Scarpellini P;Castagna A;COVID-BioB study group
我们研究的目的是描述2019冠状病毒病（COVID-19）患者继发感染的发生率和预测因素。这是一项针对2020年2月25日至4月6日期间在IRCCS San Raffaele医院因COVID-19住院的患者的队列研究（NCT 04318366）。我们认为继发性血流感染（BSI）或可能的下呼吸道感染（pLRTI）发生在入院后48小时，直至死亡或出院。我们计算了多变量Fine-Gray模型来评估与继发感染风险相关的因素。在731例患者中，68例患者（9.3%）诊断为继发感染; 58/731例患者（7.9%）至少有1例BSI，22/731例患者（3.0%）至少有1例pLRTI。总体28天累积发生率为16.4%（95%CI 12.4-21.0%）。大多数BSI是由革兰氏阳性病原体（76/106株，71.7%）引起的，特别是凝固酶阴性葡萄球菌（53/76，69.7%），而在革兰氏阴性菌（23/106，21.7%）中，鲍曼不动杆菌（7/23，30.4%）和大肠埃希菌（5/23，21.7%）占主导地位。pLRTI主要由革兰阴性菌引起（14/26，53.8%）。11例患者被诊断为侵袭性曲霉病。在多变量分析中，与继发性感染相关的因素是基线淋巴细胞计数低（≤0.7 vs>0.7/109/L，亚分布风险比（sdHR）1.93，95%CI 1.11-3.35），基线PaO 2/FiO 2（每降低100分：sdHR 1.56，95%CI 1.21-2.04）和前48小时入住重症监护室（ICU）（sdHR 2.51，95%CI 1.04-6.05）。COVID-19住院患者继发感染的发生率很高。在多变量分析中，早期需要ICU、呼吸衰竭和严重淋巴细胞减少被确定为继发感染的危险因素。
The aim of our study was to describe the incidence and predictive factors of secondary infections in patients with coronavirus disease 2019 (COVID-19). This was a cohort study of patients hospitalized with COVID-19 at IRCCS San Raffaele Hospital between 25th February and 6th April 2020 (NCT04318366). We considered secondary bloodstream infections (BSIs) or possible lower respiratory tract infections (pLRTIs) occurring 48 hours after hospital admission until death or discharge. We calculated multivariable Fine–Gray models to assess factors associated with risk of secondary infections. Among 731 patients, a secondary infection was diagnosed in 68 patients (9.3%); 58/731 patients (7.9%) had at least one BSI and 22/731 patients (3.0%) at least one pLRTI. The overall 28-day cumulative incidence was 16.4% (95%CI 12.4–21.0%). Most of the BSIs were due to Gram-positive pathogens (76/106 isolates, 71.7%), specifically coagulase-negative staphylococci (53/76, 69.7%), while among Gram-negatives (23/106, 21.7%) Acinetobacter baumanii (7/23, 30.4%) and Escherichia coli (5/23, 21.7%) predominated. pLRTIs were caused mainly by Gram-negative pathogens (14/26, 53.8%). Eleven patients were diagnosed with putative invasive aspergillosis. At multivariable analysis, factors associated with secondary infections were low baseline lymphocyte count (≤0.7 versus >0.7 per 109/L, subdistribution hazard ratios (sdHRs) 1.93, 95%CI 1.11–3.35), baseline PaO2/FiO2 (per 100 points lower: sdHRs 1.56, 95%CI 1.21–2.04), and intensive-care unit (ICU) admission in the first 48 hours (sdHR 2.51, 95%CI 1.04–6.05). Patients hospitalized with COVID-19 had a high incidence of secondary infections. At multivariable analysis, early need for ICU, respiratory failure, and severe lymphopenia were identified as risk factors for secondary infections.
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影响因子：
5.7
作者：
Pagnesi, Matteo;Baldetti, Luca;Cappelletti, Alberto Maria
通讯作者：
Cappelletti, Alberto Maria
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
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通讯作者：
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影响因子：
11.8
作者：
Cao, Jianlei;Tu, Wen-Jun;Liu, Qiang
通讯作者：
Liu, Qiang
影响因子：
11.5
作者：
Kim, Haesook T.
通讯作者：
Kim, Haesook T.
影响因子：
158.5
作者：
Guan, W.;Ni, Z.;Zhong, N.
通讯作者：
Zhong, N.