Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients.
Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients.
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DOI：
10.1016/j.xcrm.2021.100229
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发表时间：
2021-04-20
期刊：
影响因子：
--
通讯作者：
Brugger SD
中科院分区：
文献类型：
--
作者：
Buehler PK;Zinkernagel AS;Hofmaenner DA;Wendel Garcia PD;Acevedo CT;Gómez-Mejia A;Mairpady Shambat S;Andreoni F;Maibach MA;Bartussek J;Hilty MP;Frey PM;Schuepbach RA;Brugger SD
2019冠状病毒病（COVID-19）继发细菌感染（超感染）的影响尚不清楚。在这项前瞻性、单中心队列研究中，我们旨在探讨重复感染对COVID-19急性呼吸窘迫综合征患者的影响。通过气管支气管分泌物、支气管肺泡灌洗和血培养的纵向分析来评估患者是否伴有微生物感染。在45例危重患者中，我们发现19例重复感染（42.2%）。在重症监护入院后第10天发现重复感染。在研究第28天（28天无呼吸机天数[vfd]），重复感染患者存活和关闭有创机械通气的参与者比例明显较低（亚危险比0.37；95%可信区间[CI] 0.15-0.90; p = 0.028）。肺部重复感染患者有较高的菌血症、病毒再激活、酵母菌定植发生率，需要较长时间的重症监护治疗。尽管经验性抗生素治疗的比例很高，但重复感染是常见的，并且与28天vfd降低有关。继发性细菌感染（超感染）见于42%的患者。细菌超感染发生在重症监护入院后第10天。细菌超感染与较长的通气时间有关。细菌超感染主要由革兰氏阴性菌引起。Buehler等研究表明，在COVID-19患者中，检测到细菌性肺部超感染与更严重的病程有关。特别是在研究第28天（28天无呼吸机）存活和关闭有创机械通气的可能性更低。
The impact of secondary bacterial infections (superinfections) in coronavirus disease 2019 (COVID-19) is not well understood. In this prospective, monocentric cohort study, we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages, and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days [VFDs] at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37; 95% confidence interval [CI] 0.15–0.90; p = 0.028). Patients with pulmonary superinfections have a higher incidence of bacteremia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy. Secondary bacterial infections (superinfections) are found in 42% of patients Bacterial superinfections occur on day 10 after intensive care admission Bacterial superinfections are associated with longer duration of ventilation Bacterial superinfections are mostly caused by Gram-negative bacteria Buehler et al. show that detection of bacterial pulmonary superinfection is associated with a more severe disease course in COVID-19 patients, especially a lower likelihood of being alive and off invasive mechanical ventilation at study day 28 (ventilator-free days at 28 days).
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影响因子：
15.1
作者：
Garcia, Pedro David Wendel;Fumeaux, Thierry;Hilty, Matthias Peter
通讯作者：
Hilty, Matthias Peter
DOI：
10.1016/j.cmi.2020.12.005
发表时间：
2020-12-13
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Dellière S;Dudoignon E;Fodil S;Voicu S;Collet M;Oillic PA;Salmona M;Dépret F;Ghelfenstein-Ferreira T;Plaud B;Chousterman B;Bretagne S;Azoulay E;Mebazaa A;Megarbane B;Alanio A
通讯作者：
Alanio A
影响因子：
5.5
作者：
Frey, Pascal M.;Marti, Grischa R.;Brugger, Silvio D.
通讯作者：
Brugger, Silvio D.
影响因子：
9.6
作者：
Martin-Loeches, Ignacio;Sanchez-Corral, Ana;Rodriguez, Alejandro
通讯作者：
Rodriguez, Alejandro
影响因子：
4.9
作者：
Koehler, Philipp;Cornely, Oliver A.;Shimabukuro-Vornhagen, Alexander
通讯作者：
Shimabukuro-Vornhagen, Alexander