COVID-19是多重耐药菌感染/定植的危险因素吗？——COVID-19大流行期间一项住院患者多重耐药菌感染调查

Is COVID-19 a risk factor for infection/colonization with multidrug-resistant organisms? A survey on multidrug-resistant organisms infection in hospitalized patients during the COVID-19 pandemic

摘要:

目的 医院大规模收治新型冠状病毒感染(COVID-19)患者的状况下,分析COVID-19是否为住院患者多重耐药菌(MDRO)感染/定植的潜在危险因素。方法 回顾性分析2022年12月1日—2023年1月31日某三级甲等医院的住院患者资料。比较COVID-19患者与非COVID-19患者的临床资料、抗菌药物治疗情况、MDRO检出情况。将检出病原菌的患者分为MDRO组和非MDRO组,采用多因素logistic回归分析住院患者MDRO感染/定植的危险因素。结果 收治各类住院患者共16 710例,其中COVID-19组2 403例,8.83%(113/1 280)检出MDRO;非COVID-19组14 307例,4.43%(167/3 770)检出MDRO。COVID-19组患者耐碳青霉烯类肺炎克雷伯菌(CRKP)检出率高于非COVID-19组(48.15% VS 30.89%,P=0.028)。多因素分析结果显示,危重患者(OR=4.796, 95%CI:3.524~6.527)、培养前接受抗菌药物治疗≥2 d(OR=2.330, 95%CI:1.699~3.196)、培养出真菌(OR=1.780,95%CI:1.318~2.405)、住院日数长(OR=1.036,95%CI:1.030~1.042)是住院患者MDRO感染/定植的危险因素(均P＜0.05)。结论 医院大规模收治COVID-19患者期间,MDRO感染/定植与是否为危重患者、抗菌药物使用、培养出真菌、住院日数长有关,COVID-19不是MDRO感染/定植的危险因素。

Abstract:

Objective To analyze whether coronavirus disease 2019 (COVID-19) is a potential risk for the infection/colonization with multidrug-resistant organisms (MDROs) in hospitalized patients during a surge admission of COVID-19 patients. Methods Data of hospitalized patients in a tertiary first-class hospital from December 1, 2022 to January 31, 2023 were retrospectively analyzed. Clinical data, antimicrobial therapy, and MDROs detection result between COVID-19 patients and non-COVID-19 patients were compared. Patients with detected pathogens were divided into MDRO group and non-MDRO group. Risk factors for infection/colonization with MDROs in hospitalized patients were analyzed by multivariate logistic regression. Results A total of 16 710 patients were admitted in hospital, 2 403 cases were in COVID-19 group, and 8.83% (113/1 280) were MDRO-infected cases; 14 307 cases were in non-COVID-19 group, and 4.43% (167/3 770) were MDRO-infected cases. The detection rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) in patients in COVID-19 group was higher than that in non-COVID-19 group (48.15% vs 30.89%, P=0.028). Multivariate analysis Results showed that critical illness (OR=4.796, 95%CI: 3.524-6.527), antimicrobial therapy ≥2 days before pathogen culture (OR=2.330, 95%CI: 1.699-3.196), positive fungi culture (OR=1.780, 95%CI: 1.318-2.405), long hospital stay (OR=1.036, 95%CI: 1.030-1.042) were risk factors for MDRO infection/colonization in hospitalized patients (all P<0.05). Conclusion During mass admission of COVID-19 patients, MDROs infection/colonization is related to critical illness, antimicrobial use, positive fungi culture and long hospital stay, while COVID-19 infection is not a risk factor for MDROs infection/colonization.