目的:COVID-19患者的血流感染与较高的死亡率有关,而流行病学和耐药模式的数据仍然缺乏,以指导管理和预防抗生素耐药性。这项研究的重点是患病率,临床特征,致病微生物,住院COVID-19患者细菌和真菌继发血流共感染的抗菌药物敏感性。
方法:在这项回顾性研究中,分析了来自台湾中部(2021年6月至2022年6月)的230例COVID-19患者,通过MALDI-TOFMS和Vitek2系统与临床和实验室标准协会(CLSI)标准鉴定病原体。
结果:在队列中,17.8%的人经历了血液感染,从41例血流感染患者中分离出45株:主要是革兰氏阳性菌(葡萄球菌和肠球菌),占69%,29%的革兰阴性(大肠杆菌和肺炎克雷伯菌),和真菌在2%。感染患者的白细胞计数(WBC)水平显着升高,C反应蛋白(CRP)和降钙素原(PCT)。值得注意的是,对普通抗生素的耐药性,如氟喹诺酮类药物,头孢菌素,苯唑西林很重要,尤其是肺炎克雷伯菌,不动杆菌属,和金黄色葡萄球菌感染。
结论:我们的研究强调了细菌感染对COVID-19住院患者的影响。发现细菌感染影响COVID-19的临床轨迹,可能加剧或减轻其症状,严重程度和死亡。这些见解对于解决COVID-19管理中的临床挑战至关重要,并强调需要量身定制的医疗干预措施。因此,了解这些共同感染对于在后COVID-19大流行时代优化患者护理和改善整体结果至关重要。
OBJECTIVE: Bloodstream infections in patients with COVID-19 are linked to higher mortality rates, whilst data on epidemiology and resistance patterns remains scarce to guide management and prevent antibiotic resistance. This research focuses on the prevalence, clinical features, causative microorganisms, and antimicrobial susceptibility of bacterial and fungal secondary bloodstream co-infections in hospitalized patients with COVID-19.
METHODS: In this retrospective study analysis of 230 patients with COVID-19 from Central Taiwan (June 2021 to June 2022), pathogens were identified via MALDI-TOF MS and Vitek 2 system with Clinical & Laboratory Standards Institute (CLSI) standards.
RESULTS: In the cohort, 17.8% experienced bloodstream infections, resulting in a total of 45 isolates from the 41 bloodstream infection patients: predominantly gram-positive bacteria (Staphylococcus and Enterococcus) at 69%, gram-negative at 29% (Escherichia coli and Klebsiella pneumoniae), and fungi at 2%. Infected patients showed significantly elevated levels of white blood count (WBC), C-reactive protein (CRP) and procalcitonin (PCT). Of note, resistance to common antibiotics, such as fluoroquinolones, cephalosporins, and oxacillin was significant, especially in K. pneumoniae, Acinetobacter species, and S. aureus infections.
CONCLUSIONS: Our study highlights the influence of bacterial infections in hospitalized patients with COVID-19. The bacterial infections were discovered to impact the clinical trajectory of COVID-19, potentially exacerbating or mitigating its symptoms, severity and fatality. These insights are pivotal to addressing clinical challenges in COVID-19 management and underscoring the need for tailored medical interventions. Understanding these co-infections is thus essential for optimizing patient care and improving overall outcomes in the post COVID-19 pandemic era.