ICU-Acquired Superinfections Before And During The COVID-19 Pandemic: Similarities And Differences.

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Heart & Lung Pub Date : 2025-01-14 DOI:10.1016/j.hrtlng.2025.01.002

Sasha-Jane Abi-Aad, Hind Eid, Carine Harmouche, Tara Daoud, Maissa Safieddine, Georges Dabar

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Abstract

Background: During the COVID-19 pandemic, intensive care units (ICUs) experienced a surge in patients with viral pneumonia, often leading to acute respiratory failure. A global rise in ICU superinfections was observed; however, it remains unclear whether the extensive use of broad-spectrum antibiotics, corticosteroids, and immunosuppressants contributed to this rise.

Objectives: We aim to identify clinical factors associated with these superinfections while analyzing epidemiologic patterns of superinfections in two different periods.

Methods: We conducted a retrospective study comparing ICU patients admitted between January 2016 and December 2018 (control group) with those admitted due to hypoxemic respiratory failure from SARS-CoV-2 between September 2020 and February 2022. Clinical characteristics were analyzed after propensity score matching, and a subsequent multivariate analysis was conducted on the COVID-19 population to identify independent risk factors for superinfections.

Results: 1456 patients were identified in the pre-COVID group and 164 in the COVID-19 group. The mean age was similar (64 years), but the pre-COVID-19 group was sicker. After matching, 427 pre-COVID-19 and 163 COVID-19 patients were analyzed. COVID-19 patients experienced higher superinfection rates (42 % vs. 12 %, p < 0.001), were more obese, and had greater exposure to antibiotics and corticosteroids. After multivariate analysis of the COVID-19 population, ICU length of stay (OR=1.09, p = 0.01) and mechanical ventilation (OR=5.05, p = 0.008) were independent risk factors for superinfections.

Conclusion: Increased superinfection rates in COVID-19 patients were linked to mechanical ventilation and prolonged ICU stays, potentially influenced by MDR infections linked to antibiotics and corticosteroids. Further investigations are needed to establish causality.

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COVID-19大流行之前和期间的重症监护病房获得性超级感染：异同

背景：在2019冠状病毒病大流行期间，重症监护病房（icu）的病毒性肺炎患者激增，往往导致急性呼吸衰竭。观察到ICU重复感染的全球上升；然而，目前尚不清楚广谱抗生素、皮质类固醇和免疫抑制剂的广泛使用是否导致了这种上升。目的：我们的目的是在分析两个不同时期的重复感染的流行病学模式的同时，确定与这些重复感染相关的临床因素。方法：对2016年1月至2018年12月ICU收治的患者（对照组）与2020年9月至2022年2月因SARS-CoV-2低氧性呼吸衰竭入院的患者进行回顾性研究。倾向评分匹配后分析临床特征，随后对COVID-19人群进行多因素分析，以确定重复感染的独立危险因素。结果：预感染组1456例，新冠感染组164例。平均年龄相似（64岁），但covid -19前组病情更重。匹配后，分析427例COVID-19前期患者和163例COVID-19患者。COVID-19患者有更高的重复感染率（42%对12%，p < 0.001），更肥胖，更多地接触抗生素和皮质类固醇。对COVID-19人群进行多因素分析，ICU住院时间（OR=1.09, p = 0.01）和机械通气（OR=5.05, p = 0.008）是重复感染的独立危险因素。结论：COVID-19患者的重复感染率增加与机械通气和ICU住院时间延长有关，可能受到抗生素和皮质类固醇相关的耐多药感染的影响。需要进一步调查以确定因果关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.