Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU
Bacterial and viral co-infections in patients with severe SARS-CoV-2 pneumonia admitted to a French ICU
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DOI：
10.1186/s13613-020-00736-x
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发表时间：
2020-09-07
影响因子：
8.1
通讯作者：
Plantefeve, Gaetan
中科院分区：
文献类型：
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作者：
Contou, Damien;Claudinon, Aurore;Plantefeve, Gaetan
背景：目前ICU收治的SARS-CoV-2肺炎相关急性呼吸衰竭患者中细菌和病毒合并感染的流行情况缺乏相关数据。我们的目的是评估细菌和病毒合并感染的发生率，并报告重症监护病房收治的SARS-CoV-2肺炎患者中最常见的微生物。在这项单中心回顾性研究中，我们回顾了因急性呼吸衰竭入院的COVID-19患者（SARS-CoV-2 RT-PCR阳性）入院前48小时内进行的所有呼吸微生物学调查。结果2020年3月13日至4月16日，共有92例成人患者（年龄中位数：61岁，第1- 3四分位数[55-70]），男性：n = 73/ 92,79%，基线SOFA: 4[3-7]和SAPS: 31[21-40]，有创机械通气：n = 83/ 92,90%， ICU死亡率：n = 45/ 92,49%)入住40张床位的ICU。其中26例（28%）在ICU入院时被认为合并感染一种致病菌，未合并感染非典型细菌或病毒。从培养和/或呼吸道pcr中分离到的32种细菌分布如下：甲氧西林敏感金黄色葡萄球菌（n = 10/ 32,31 %）、流感嗜血杆菌（n = 7/ 32,22 %）、肺炎链球菌（n = 6/ 32,19 %）、肠杆菌科（n = 5/ 32,16 %）、铜绿假单胞菌（n = 2/ 32,6 %）、卡他莫拉菌（n = 1/ 32,3 %）和鲍曼不动杆菌（n = 1/ 32,3 %）。培养分离的24株病原菌中，对第3代头孢菌素耐药2株（8%），对阿莫西林-克拉维酸联合耐药5株（21%）。我们报告重症SARSCoV-2肺炎患者在ICU入院时的细菌共感染率为28%，主要与金黄色葡萄球菌、流感嗜血杆菌、肺炎链球菌和肠杆菌科相关。在确诊需要ICU住院的法国严重SARSCoV-2肺炎患者中，我们的研究结果鼓励系统地给予经验性抗生素单药治疗，并使用第三代头孢菌素，并尽快降低剂量。需要进一步开展更大规模的研究，以评估合并感染的真实患病率和预测因素，以及其对重症SARS-CoV-2肺炎危重患者的预后影响。
Background Data on the prevalence of bacterial and viral co-infections among patients admitted to the ICU for acute respiratory failure related to SARS-CoV-2 pneumonia are lacking. We aimed to assess the rate of bacterial and viral co-infections, as well as to report the most common micro-organisms involved in patients admitted to the ICU for severe SARS-CoV-2 pneumonia. Patients and methods In this monocenter retrospective study, we reviewed all the respiratory microbiological investigations performed within the first 48 h of ICU admission of COVID-19 patients (RT-PCR positive for SARS-CoV-2) admitted for acute respiratory failure. Results From March 13th to April 16th 2020, a total of 92 adult patients (median age: 61 years, 1st-3rd quartiles [55-70]; males:n = 73/92, 79%; baseline SOFA: 4 [3-7] and SAPS II: 31 [21-40]; invasive mechanical ventilation:n = 83/92, 90%; ICU mortality:n = 45/92, 49%) were admitted to our 40-bed ICU for acute respiratory failure due to SARS-CoV-2 pneumonia. Among them, 26 (28%) were considered as co-infected with a pathogenic bacterium at ICU admission with no co-infection related to atypical bacteria or viruses. The distribution of the 32 bacteria isolated from culture and/or respiratory PCRs was as follows: methicillin-sensitiveStaphylococcus aureus(n = 10/32, 31%),Haemophilus influenzae(n = 7/32, 22%),Streptococcus pneumoniae(n = 6/32, 19%), Enterobacteriaceae (n = 5/32, 16%),Pseudomonas aeruginosa(n = 2/32, 6%),Moraxella catarrhalis(n = 1/32, 3%) andAcinetobacter baumannii(n = 1/32, 3%). Among the 24 pathogenic bacteria isolated from culture, 2 (8%) and 5 (21%) were resistant to 3rd generation cephalosporin and to amoxicillin-clavulanate combination, respectively. Conclusions We report on a 28% rate of bacterial co-infection at ICU admission of patients with severe SARSCoV-2 pneumonia, mostly related toStaphylococcus aureus, Haemophilus influenzae,Streptococcus pneumoniaeand Enterobacteriaceae. In French patients with confirmed severe SARSCoV-2 pneumonia requiring ICU admission, our results encourage the systematic administration of an empiric antibiotic monotherapy with a 3rd generation cephalosporin, with a prompt de-escalation as soon as possible. Further larger studies are needed to assess the real prevalence and the predictors of co-infection together with its prognostic impact on critically ill patients with severe SARS-CoV-2 pneumonia.