Risks and features of secondary infections in severe and critical ill COVID-19 patients.
Risks and features of secondary infections in severe and critical ill COVID-19 patients.
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DOI：
10.1080/22221751.2020.1812437
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发表时间：
2020-12
影响因子：
13.2
通讯作者：
Zhang W
中科院分区：
文献类型：
--
作者：
Zhang H;Zhang Y;Wu J;Li Y;Zhou X;Li X;Chen H;Guo M;Chen S;Sun F;Mao R;Qiu C;Zhu Z;Ai J;Zhang W
目的重症或危重症COVID-19患者需入住重症监护室，继发感染率增加，预后显著恶化。尚未描述与严重COVID-19继发感染相关的风险和特征。方法收集上海市2019冠状病毒病重症和危重症患者。我们根据临床需要采集下呼吸道、尿液、导管和血液样本，并进行培养和mNGS。将临床和实验室数据存档。结果57.89%（22/38）的患者发生继发感染。有创机械通气和危重患者继发感染的机会明显高于无创机械通气和危重患者（P<0.0001）。呼吸道感染以革兰阴性菌为主（26株，占50.00%），其次为革兰阳性菌（14株，占26.92%）、病毒（6株，占11.54%）、真菌（4株，占7.69%）、其他（2株，占3.85%）。高流量、气管插管和气管切开后呼吸道感染率分别为12.90%（4/31）、30.43%（7/23）和92.31%（12/13）。继发感染会导致出院率降低和死亡率升高。结论我们的研究首次说明了重症和危重COVID-19患者的继发感染比例。培养结合宏基因组测序提高了病原体诊断率。接受有创呼吸机和血管内器械后继发感染的风险增加，导致出院率降低和死亡率升高。
Objectives Severe or critical COVID-19 is associated with intensive care unit admission, increased secondary infection rate, and would lead to significant worsened prognosis. Risks and characteristics relating to secondary infections in severe COVID-19 have not been described. Methods Severe and critical COVID-19 patients from Shanghai were included. We collected lower respiratory, urine, catheters, and blood samples according to clinical necessity and culture and mNGS were performed. Clinical and laboratory data were archived. Results We found 57.89% (22/38) patients developed secondary infections. The patient receiving invasive mechanical ventilation or in critical state has a higher chance of secondary infections (P<0.0001). The most common infections were respiratory, blood-stream and urinary infections, and in respiratory infections, the most detected pathogens were gram-negative bacteria (26, 50.00%), following by gram-positive bacteria (14, 26.92%), virus (6, 11.54%), fungi (4, 7.69%), and others (2, 3.85%). Respiratory Infection rate post high flow, tracheal intubation, and tracheotomy were 12.90% (4/31), 30.43% (7/23), and 92.31% (12/13) respectively. Secondary infections would lead to lower discharge rate and higher mortality rate. Conclusion Our study originally illustrated secondary infection proportion in severe and critical COVID-19 patients. Culture accompanied with metagenomics sequencing increased pathogen diagnostic rate. Secondary infections risks increased after receiving invasive respiratory ventilations and intravascular devices, and would lead to a lower discharge rate and a higher mortality rate.
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影响因子：
28.2
作者：
Zhang, Hao-Cheng;Ai, Jing-Wen;Zhang, Wen-Hong
通讯作者：
Zhang, Wen-Hong
影响因子：
15.5
作者：
Zhang, Lingdi;Forst, Christian, V;Ghedin, Elodie
通讯作者：
Ghedin, Elodie
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：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,
影响因子：
39.2
作者：
Friedman, ND;Kaye, KS;Sexton, DJ
通讯作者：
Sexton, DJ
甲型流感病毒与肺炎链球菌合并感染的动力学。
影响因子：
6.7
作者：
Smith AM;Adler FR;Ribeiro RM;Gutenkunst RN;McAuley JL;McCullers JA;Perelson AS
通讯作者：
Perelson AS