COVID-19 HASTALARINDA SEKONDER ENFEKSİYONLAR VE LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ: ÜNİVERSİTE HASTANESİNDE YAPILAN RETROSPEKTİF BİR ÇALIŞMA

Year 2022, , 64 - 73, 31.08.2022

Berna Erdal , Beyza Keskin Nejat Altıntaş Nuri Kiraz

https://doi.org/10.54962/ankemderg.1163275

Abstract

Sekonder enfeksiyonlar, COVID-19 ile hastaneye yatırılan hastalarda yüksek mortaliteye yol açan başlıca komplikasyonlar arasındadır. Bu çalışmada, COVID-19 hastalarında gelişen sekonder enfeksiyonların prevalansı, risk faktörleri, etiyolojik ajanları ve antimikrobiyal direnç paternlerinin belirlenmesi amaçlanmıştır. Çalışmaya 48 saat hastanede yattıktan sonra sekonder bakteriyel ve fungal enfeksiyon gelişen, COVID-19 PCR testi pozitif olan hastalar dahil edilmiştir. Hastaların klinik örneklerinden elde edilen bakteri ve mantar kültürlerinin sonuçları retrospektif olarak değerlendirilmiştir. Bu çalışmanın sonunda hastanede yatan 267 hastanın %16.1'inde (n=43) sekonder enfeksiyon geliştiği belirlenmiştir. Sekonder enfeksiyonlar erkeklerde (n=28, %65.1) kadınlara (n=15, %34.9) göre daha fazla saptanmıştır (p=0.024). Sekonder enfeksiyonu olan hastaların medyan yaşı (65.0 yıl) daha yüksek bulunmuştur (p<0.05). Sekonder enfeksiyonlu 43 hastanın %93'ünde (n=40) komorbidite saptanmıştır. Sekonder enfeksiyon gelişen hastaların 29'unun (%67.4) yoğun bakım ünitelerinde, 14'ünün (%32.6) servislerde tedavi gördüğü belirlenmiştir (p<0.001). Sekonder enfeksiyonların hastanede kalış süresini uzattığı (ortalama 25.5 gün) ve mortaliteyi artırdığı (n=16, %37.2) bulunmuştur (p<0.001). Etken ajan olarak tanımlanan ilk üç mikroorganizma, metisiline dirençli koagülaz negatif stafilokoklar (n=21, %16.3), Acinetobacter baumannii (n=19, %14.7) ve Candida albicans’tır (n=14, %10.9). Acinetobacter baumannii izolatlarının karbapenem direnç oranları %94.7 saptanmıştır. Koagülaz negatif stafilokokların %100'ünde metisilin direnci bulunurken vankomisin, teikoplanin ve linezolid direnci saptanmamıştır. C. albicans (%10.9) izolatlarında test edilen antifungal ajanlara karşı direnç bulunmamıştır. Sekonder enfeksiyonlar arasında özellikle pnömoni (n=25, %36.3), kan dolaşımı enfeksiyonları (n=19, %27.6) ve idrar yolu (n=18, %26.1) enfeksiyonları ilk sırada yer almıştır. COVID-19 ile ilişkili olarak gelişen sekonder enfeksiyonların ve risk faktörlerinin saptanması, etken mikroorganizmaların tanımlanması ve antimikrobiyal direnç paternlerinin belirlenmesi hastalığın prognozu, enfeksiyon kontrolü ve antimikrobiyal yönetimi açısından oldukça önemlidir.

Keywords

COVID-19, patojen, risk faktörleri, sekonder enfeksiyon, Türkiye

Secondary Infections in Patients with COVID-19 and Review of the Literature: A Retrospective Study Conducted at a University Hospital

Abstract

Secondary infections are among the main complications leading to high mortality in patients hospitalized with COVID-19. This study aimed to determine the prevalence, risk factors, etiological agents and antimicrobial resistance patterns of secondary infections that developed in patients with COVID-19. In the study, patients with a positive COVID-19 PCR test who developed secondary bacterial and fungal infections after 48 hours of hospitalization were included. The results of the bacterial and fungal cultures obtained from the clinical samples of the patients were retrospectively evaluated. At the end of this study, it was determined that 16.1% (n=43) of 267 hospitalized patients developed secondary infections. Secondary infections were detected more in males (n=28, 65.1%) than females (n=15, 34.9%) (p=0.024). The median age (65.0 years) of patients with secondary infection was found to be higher (p<0.05). Comorbidity was detected in 93% (n=40) of 43 patients with secondary infections. It was found that 29 (67.4%) of the patients who developed secondary infection were treated in ICU and 14 (32.6%) were treated in the services (p<0.001). Secondary infections found to prolong hospital stay (median 25.5 days) and increase mortality (n=16, 37.2%) (p<0.001). The first three microorganisms identified as causative agents were methicillin-resistant coagulase-negative staphylococci (n=21, 16.3%), Acinetobacter baumannii (n=19, 14.7%) and Candida albicans (n=14, 10.9%). Carbapenem resistance rates of Acinetobacter baumannii isolates were 94.7%. While methicillin resistance was found in 100% of coagulase negative staphylococci, no resistance was found to vancomycin, teicoplanin and linezolid. No resistance was found to the tested antifungal agents in C. albicans (10.9%) isolates. Among secondary infections, especially pneumonia (n=25, 36.3%), bloodstream infections (n=19, 27.6%) and urinary tract infections (n=18, 26.1%) ranked first. Detection of secondary infections and risk factors associated with COVID-19, identification of causative microorganisms and determination of antimicrobial resistance patterns are very important in terms of prognosis, infection control and antimicrobial management of the disease.

Keywords

COVID-19, pathogen, risc factors, secondary infection, Turkey

References

• Cai Q, Huang D, Ou P, et al. COVID‐19 in a designated infectious diseases hospital outside Hubei Province, China. Allergy. 2020;75(7):1742-52.
• Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Investig. 2020;130(5):2620-9.
• Chen N, Zhou M, Dong X, et al. Show all authors et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
• CLSI. Performance standards for antimicrobial susceptibility testing, M100, 29th ed. Wayne, PA: Clinical and Laboratory Standards Institute, (2019).
• CLSI. Reference method for broth dilution antifungal susceptibility testing of yeasts; Approved Standard Third Edition; CLSI document M27-A3. Wayne, PA: Clinical Laboratory Standards Institute, (2008).
• European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters Version 9.0, http://www.eucast.org [erişim 01.08.2022].
• Feng Y, Ling Y, Bai T, et al. COVID-19 with different severities: a multicenter study of clinical features. Am J Respirat Crit Care Med. 2020;201(11):1380-8.
• Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2020;19:1-14.
• Kan Dolaşımı Örneklerinin Laboratuvar İncelemesi Rehberi, s.37-39, 2.Baskı, 2022/ANKARA.KLİMUD.KAN.REH.04/22.Ver02.
• Klinik Örnekten Sonuç Raporuna Uygulama Rehberi, Solunum Sistemi Örnekleri, s.44-62. Klinik Mikrobiyoloji Uzmanlık Derneği Yayınları, Aralık 2015, Ankara.
• Lamptey R, Ahomagnon S, Acheampong F, Kalra S. Glucovigilance in COVID-19. J Pak Med Assoc. 2020;70(5):80-2.
• Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622-9.
• Li J, Wang J, Yang Y, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: A Retrospective Analysis. Antimicro Resist Infect Cont. 2020;9(1):1-7.
• Malik YA. Properties of coronavirus and SARS-CoV-2. Malays J Pathol. 2020;42(1):3-11. PMID: 32342926.
• Özdemir YE, Balkan İİ, Bayramlar OF, Alkan S. Clinical Characteristics of Mild-Moderate COVID-19 Patients and Risk Factors for the Development of Pneumonia. Mikrobiyol Bul. 2021;55(3):342-56.
• Parrill A, Tsao T, Dong V, Huy NT. SARS-CoV-2-induced immunodysregulation and the need for higher clinical suspicion for co-infection and secondary infection in COVID-19 patients. J Microbiol Immunol Infect. 2021;54(1):105-8.
• Rawson TM, Moore LS, Zhu N, et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Diseases. 2020;71(9):2459-68.
• Ripa M, Galli L, Poli A, et al. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors. Clin Microbiol Infect. 2021;27(3):451-7.
• T.C.S.B.: COVID-19 Bilgilendirme Platformu. Available from: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html (Accessed date: 6 March 2022).
• T.C.S.B.: COVID-19 Bilgilendirme Platformu. Available from: https://covid19.saglik.gov.tr/TR-66301/covid-19-rehberi.html (Accessed date: 6 March 2022).
• Vaillancourt M, Jorth P. The unrecognized threat of secondary bacterial infections with COVID-19. Mbio. 2020;11(4): e01806-20.
• Wang C, Liu Z, Chen Z, et al. The establishment of reference sequence for SARS‐CoV‐2 and variation analysis. J Med Virol. 2020; 92(6): 667-74.
• Wang L, He W, Yu X, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80(6):639-45.
• WHO: WHO Coronavirus (COVID-19) Dashboard. Available from: https://covid19.who.int (Accessed date: 6 March 2022).
• Wu X, Cai Y, Huang X, et al. Co-infection with SARS-CoV-2 and influenza A virus in patient with pneumonia, China. Emerg Infect Diseases. 2020;26(6):1324.
• Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respirat Med. 2020; 8(5):475-81.
• Zhang H, Zhang Y, Wu J, et al. Risks and features of secondary infections in severe and critical ill COVID-19 patients. Emerg Microbes Infect. 2020;9(1):1958-64.
• Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.