Healthcare-associated infections: a threat to the survival of patients with COVID-19 in intensive care units.

Autor: de Macedo V; Hospital Infection Control and Epidemiology Center, Santa Casa de Curitiba, Curitiba, Paraná, Brazil; Positive University, Medicine School, Curitiba, Paraná, Brazil; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Electronic address: vioakmac@gmail.com., Santos GS; Hospital Infection Control and Epidemiology Center, Rehabilitation Hospital, Curitiba, Paraná, Brazil., Silva RN; Infection Control Program, Hospital de Clínicas, Curitiba, Paraná, Brazil., Couto CNM; Pontifical Catholic University of Paraná, Medicine School, Curitiba, Paraná, Brazil., Bastos C; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Viecelli E; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Mateus MN; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Graf ME; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Gonçalves RB; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Silva MA; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Bernardini PDB; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Grando RSP; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Boaventura VP; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Pereira HSR; Hospital Infection Control and Epidemiology Center, Trabalhador Hospital, Curitiba, Paraná, Brazil., Levin ASS; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2022 Aug; Vol. 126, pp. 109-115. Date of Electronic Publication: 2022 May 25.
DOI: 10.1016/j.jhin.2022.05.013
Abstrakt: Background: Wide variation in mortality rates among critically ill patients with coronavirus disease 2019 (COVID-19) has been reported. This study evaluated whether healthcare-associated infections (HAI) are a risk factor for death among patients with severe COVID-19 in the intensive care unit (ICU).
Methods: This retrospective cohort study included patients with severe COVID-19 hospitalized in the ICU of four hospitals in the city of Curitiba, Brazil. Patients with COVID-19 who died during ICU hospitalization were compared with those who were discharged. A second analysis compared patients who developed HAI in the ICU with those who did not. Multiple logistic regression models were used to control for confounders.
Results: In total, 400 patients were included, and 123 (31%) patients developed HAI. The most common HAI was lower respiratory tract infection (67%). Independent risk factors for death were: age [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.43-2.15; P<0.0001]; clinical severity score (OR 2.21, 95% CI 1.70-2.87; P<0.0001); renal replacement therapy (OR 12.8, 95% CI 5.78-28.6; P<0.0001); and HAI (OR 5.9, 95% CI 3.31-10.5; P<0.0001). A longer interval between symptom onset and hospital admission was protective against death (OR 0.93, 95% CI 0.88-0.98; P=0.017). The only independent factors associated with HAI were high C-reactive protein and low PaO 2 /FiO 2 ratio.
Conclusions: No factors that could point to a high-risk group for HAI acquisition were identified. However, age, dialysis and HAI increased the risk of death in ICU patients with severe COVID-19; of these, HAI is the only preventable risk factor.
(Copyright © 2022. Published by Elsevier Ltd.)
Databáze: MEDLINE
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