Bloodstream infections in critically ill patients with COVID-19
Bloodstream infections in critically ill patients with COVID-19
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DOI：
10.1111/eci.13319
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发表时间：
2020-08-11
影响因子：
5.5
通讯作者：
Bassetti, Matteo
中科院分区：
文献类型：
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作者：
Giacobbe, Daniele Roberto;Battaglini, Denise;Bassetti, Matteo
关于2019冠状病毒病（COVID-19）危重患者重症监护病房（ICU）获得性血液感染（BSI）的发生率和风险知之甚少。材料和方法本回顾性单中心研究在意大利北部进行。主要研究目的如下：(a)评估icu获得性BSI的发生率；(b)评估发生icu获得性BSI的累积风险。结果共纳入78例新冠肺炎危重患者。在31例患者中记录了45次icu获得性BSI发作，每1000患者日的风险发生率为47次（95%可信区间[CI] 35-63）。估计发生至少一次BSI发作的累积风险在风险15天后接近25%，在风险30天后可能超过50%。在多变量分析中，抗炎治疗与BSI的发展独立相关（tocilizumab的病因特异性风险比[csHR] 1.07, 95% CI 0.38-3.04，甲基强的松龙的csHR为3.95,95% CI 1.20-13.03，甲基强的松龙加tocilizumab的csHR为10.69,95% CI 2.71-42.17，无抗炎治疗作为参照组；假变量的总体p = 0.003）。结论BSI发生率较高，且住院时间越长，发生BSI的累积风险越高。进一步的研究将澄清，我们在接受抗炎药物治疗的COVID-19患者中检测到的BSI风险增加是否被减少SARS-CoV-2诱导的任何可能的促炎失调的益处所抵消。
Background Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19). Materials and methods This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI. Results Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overallPfor the dummy variable = 0.003). Conclusions The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.