Üçüncü Basamak Bir Hastanede Yatan COVID-19 Hastalarında Sekonder Enfeksiyonlar

Year 2022, Volume: 7 Issue: 1, 99 - 105, 01.03.2022

Neslihan Arıcı , Asu Özgültekin , Nilgün Kansak , Rıza Adaleti , Handan Ankaralı , Sebahat Aksaray

https://doi.org/10.26453/otjhs.1031970

Cited By: 2

Abstract

Amaç: Bu çalışmada hastanede yatan COVID-19 hastalarında sekonder enfeksiyonların oranları, etiyolojik ajanları ve klinik sonuçlara etkisinin belirlenmesi amaçlanmıştır.
Materyal ve Metot: RT-PCR yoluyla COVID-19 tanısı doğrulanmış hastanede yatan 150 yetişkin hasta arasında sekonder enfeksiyonu olan ve olmayan hastaların özelliklerinin retrospektif olarak karşılaştırmalı analizi yapıldı.
Bulgular: Dahil edilen hastaların 20'sinde (%13,3) en az bir sekonder enfeksiyon tespit edildi. Yoğun bakım hastalarında sekonder enfeksiyon oranı (%72) genel serviste yatan hastalardan (%1,6) anlamlı derecede yüksek bulundu (p<0,001). Ventilatör ilişkili pnömoni (VİP) prevalansı YBÜ hastalarında %52 idi. İzole edilen toplam 31 mikroorganizmanın çoğunluğunu gram negatif bakteriler oluşturmaktaydı. Genel olarak, 147 (%98) hasta, hastaneye yatışları esnasında en az bir kez antibiyotik tedavisi aldı. Sekonder enfeksiyonu olan hastalarda mortalite oranı, olmayanlara göre istatistiksel olarak anlamlı derecede yüksek bulundu (p<0,001).
Sonuç: Genel serviste yatan COVID-19 hastalarında sekonder enfeksiyon oranı çok düşük olduğu için, antibiyotiklerin akılcı kullanımı gereği, bu hastalara ampirik antibiyotik tedavisi başlanmaması gerektiğini düşünüyoruz. Ayrıca VİP enfeksiyonlarının hem ampirik hem de hedefe yönelik tedavisinde çoklu ilaca dirençli bakterilerin dikkate alınmasının önemli olduğunu düşünüyoruz. 

Keywords

antibiyotik kullanımı, COVİD-19, sekonder enfeksiyonlar, ventilatör ilişkili pnömoni

Secondary Infections in COVID-19 Patients Hospitalized in A Tertiary Hospital

Abstract

Objective: In this study, it was aimed to describe rates, etiological agents of the secondary infections and its effect on clinical outcomes among hospitalized patients with COVID-19.
Materials and Methods: A retrospective comparative analysis of the characteristics of patients with and without secondary infection was carried out among 150 hospitalized adult patients with a confirmed diagnosis of COVID-19 via RT-PCR.
Results: Among included patients, 20 (13.3%) had at least one secondary infection. Secondary infection rate in ICU patients (72%) was significantly higher than patients in the general ward (1.6%) (p<0.001). The prevalence of ventilator-associated pneumonia (VAP) was 52% in ICU patients. The majority of 31 microorganisms isolated were gram negative bacteria. Overall, 147 (98%) patients received at least one antibiotic during their hospitalization. A significantly higher mortality rate was present in patients with secondary infection compared to those without.
Conclusion: Since the rate of secondary infection in hospitalized COVID-19 patients in the general ward is very low, we consider that empirical antibiotic therapy should not be initiated in these patients in accordance with the rational use of antibiotics. Besides, we recommend that multidrug-resistant bacteria be taken into account both in the empirical and targeted antimicrobial therapy of VAP infections. 

Keywords

antibiotic use, COVID-19, secondary infections, ventilator-associated pneumonia

References

• Sharifipour E, Shams S, Esmkhani M, et al. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis. 2020;20(1):646.
• 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):1958-1964.
• Nori P, Cowman K, Chen V, et al. Bacterial and fungal coinfections in COVID-19 patients hospitalized during the New York City pandemic surge. Infect Control Hosp Epidemiol. 2021;42(1):84-88.
• Póvoa HCC, Chianca GC, Iorio NLPP. COVID-19: An Alert to Ventilator-Associated Bacterial Pneumonia. Infect Dis Ther. 2020;9(3):417-420.
• Crotty MP,  Akins R,  Nguyen A, Slika R, et al. Investigation of subsequent and co-infections associated with SARS-CoV-2 (COVID-19) in hospitalized patients. medRxiv. 2020. doi: 05.29.20117176.
• 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. Antimicrob Resist Infect Control. 2020;9(1):153.
• Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266-275.
• World Health Organization (WHO). COVID-19 Clinical management: living guidance. 25.01.2021. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1. Accessed March 15,2021.
• Sieswerda E, de Boer MGJ, Bonten MMJ, et al. Recommendations for antibacterial therapy in adults with COVID-19 - an evidence based guideline. Clin Microbiol Infect. 2021;27(1):61-66.
• Zhou P, Liu Z, Chen Y, Xiao Y, Huang X, Fan XG. Bacterial and fungal infections in COVID-19 patients: A matter of concern. Infect Control Hosp Epidemiol. 2020;41(9):1124-1125.
• 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):1622-1629.
• Rawson TM, Moore LSP, Zhu N, et al. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis. 2020;71(9):2459-2468.
• Infectious Diseases Society of America (IDSA). Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Available from: https://www.idsociety.org/practice-guideline/hap_vap/. Accessed March 1,2021.
• European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 10.0. Available from: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_9.0_Breakpoint_Tables.pdf; 2020. Accessed February 1,2021.
• Fu Y, Yang Q, Xu M, et al. Secondary Bacterial Infections in Critical Ill Patients With Coronavirus Disease 2019. Open Forum Infect Dis. 2020;7(6):ofaa220.
• Lee SI, Koh JS, Kim YJ, et al. Secondary infection among hospitalized COVID-19 patients: A retrospective cohort study in a tertiary care setting. Respirology. 2021;26(3):277-278.
• Goncalves Mendes Neto A, Lo KB, Wattoo A, et al. Bacterial infections and patterns of antibiotic use in patients with COVID-19. J Med Virol. 2021;93(3):1489-1495.
• Garcia-Vidal C, Sanjuan G, Moreno-García E, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27(1):83-88.
• Moretti M, Van Laethem J, Minini A, Pierard D, Malbrain MLNG. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother. 2021;27(6):826-833.
• 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):451-457.
• Dudoignon E, Caméléna F, Deniau B, et al. Bacterial Pneumonia in COVID-19 Critically Ill Patients: A Case Series. Clin Infect Dis. 2021;72(5):905-906.
• Bardi T, Pintado V, Gomez-Rojo M, et al. Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome. Eur J Clin Microbiol Infect Dis. 2021;40(3):495-502.
• Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021;21(6):149-162.
• Hughes S, Troise O, Donaldson H, Mughal N, Moore LSP. Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting. Clin Microbiol Infect. 2020;26(10):1395-1399.