危重症新型冠状病毒肺炎合并多重耐药菌感染危险因素

Risk factors for critical COVID-19 combined with multidrug-resistant organism infection

摘要:

目的 分析重型、危重型（以下简称危重症）新型冠状病毒肺炎（COVID-19）合并多重耐药菌感染的危险因素。 方法 回顾性分析某省某定点医院2020年1—4月重症隔离病区危重症COVID-19患者的临床资料，选取合并多重耐药菌感染的患者为病例组，未合并多重耐药菌感染的患者为对照组。比较两组患者临床资料，采用多因素logistic回归分析危重症COVID-19合并多重耐药菌感染的危险因素。 结果 共有62例危重症COVID-19患者。其中合并多重耐药菌感染患者10例，未合并多重耐药菌感染患者52例。62例患者中14例合并细菌或真菌感染，感染率为22.6%；10例合并多重耐药菌感染，感染率为16.1%，分别为耐碳氢霉烯类肺炎克雷伯菌（CRKP）感染4例，耐碳氢霉烯类鲍曼不动杆菌（CRAB）感染6例；合并非多重耐药菌或真菌感染共9例（11株）。单因素分析结果表明，病例组中心静脉置管比例、抗菌药物使用种类、使用抗菌药物种类≥4种比例均高于对照组；病例组清蛋白水平低于对照组；差异均有统计学意义（均P < 0.05）。多因素分析结果表明，危重症COVID-19合并多重耐药菌感染独立危险因素为抗菌药物使用种类≥4种（OR=17.104，95%CI：1.805~162.033），清蛋白为保护因素（OR=0.834，95%CI：0.709~0.982）。 结论 危重症COVID-19患者应合理使用抗菌药物，提高清蛋白水平，有利于预防与控制危重症COVID-19合并多重耐药菌感染的发生。

Abstract:

Objective To analyze risk factors for severe and critically severe (hereinafter referred to as critical) coronavirus disease 2019 (COVID-19) combined with multidrug-resistant organism(MDRO) infection. Methods Clinical data of critical COVID-19 patients in the intensive isolation wards of a designated hospital of a province from January to April 2020 were analyzed retrospectively, patients complicated with MDRO infection were selected as case group and those without MDR infection were as control group. Clinical data of two groups of patients were compared, risk factors for critical COVID-19 complicated with MDRO infection were conducted multivariate logistic regression analysis. Results There were 62 cases of critical patients with COVID-19. 10 of whom were complicated with MDRO infection, and 52 cases were not complicated with MDRO infection, 14 patients (22.6%) were complicated with bacterial or fungal infection; 10 patients (16.1%) were complicated with MDRO infection, including 4 cases of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and 6 cases of carbapenem-resistant Acine-tobacter baumannii (CRAB) infection; 9 cases (11 strains) were complicated with non-MDRO or fungal infection. Univariate analysis showed that the proportion of central venous catheterization, the types of used antimicrobial agents, and proportion of antimicrobial use ≥ 4 types in case group were all higher than those in control group; albumin level in case group was lower than control group; differences were all statistically significant (all P < 0.05). Multivariate analysis showed that independent risk factors for critical COVID-19 patients complicated with MDRO infection were the use of ≥ 4 types of antimicrobial agents (OR=17.104, 95%CI: 1.805-162.033), while albumin was the protective factor (OR=0.834, 95%CI: 0.709-0.982). Conclusion Critical COVID-19 patients should use antimicrobial agents rationally and elevate the level of albumin, which is conducive to the prevention and control of critical COVID-19 complicated with MDRO infection.