Üçüncü Basamak Bir Hastanede Yatan COVID-19 Hastalarında Sekonder Enfeksiyonlar

Öz

Amaç: Bu çalışmada hastanede yatan COVID-19 hastalarında sekonder enfeksiyonların oranları, etiyolojik ajanları ve klinik sonuçlara etkisinin belirlenmesi amaçlanmıştır.
Materyal ve Metot: RT-PCR yoluyla COVID-19 tanısı doğrulanmış hastanede yatan 150 yetişkin hasta arasında sekonder enfeksiyonu olan ve olmayan hastaların özelliklerinin retrospektif olarak karşılaştırmalı analizi yapıldı.
Bulgular: Dahil edilen hastaların 20'sinde (%13,3) en az bir sekonder enfeksiyon tespit edildi. Yoğun bakım hastalarında sekonder enfeksiyon oranı (%72) genel serviste yatan hastalardan (%1,6) anlamlı derecede yüksek bulundu (p<0,001). Ventilatör ilişkili pnömoni (VİP) prevalansı YBÜ hastalarında %52 idi. İzole edilen toplam 31 mikroorganizmanın çoğunluğunu gram negatif bakteriler oluşturmaktaydı. Genel olarak, 147 (%98) hasta, hastaneye yatışları esnasında en az bir kez antibiyotik tedavisi aldı. Sekonder enfeksiyonu olan hastalarda mortalite oranı, olmayanlara göre istatistiksel olarak anlamlı derecede yüksek bulundu (p<0,001).
Sonuç: Genel serviste yatan COVID-19 hastalarında sekonder enfeksiyon oranı çok düşük olduğu için, antibiyotiklerin akılcı kullanımı gereği, bu hastalara ampirik antibiyotik tedavisi başlanmaması gerektiğini düşünüyoruz. Ayrıca VİP enfeksiyonlarının hem ampirik hem de hedefe yönelik tedavisinde çoklu ilaca dirençli bakterilerin dikkate alınmasının önemli olduğunu düşünüyoruz. 

Anahtar Kelimeler

• antibiyotik kullanımı
• COVİD-19
• sekonder enfeksiyonlar
• ventilatör ilişkili pnömoni

Secondary Infections in COVID-19 Patients Hospitalized in A Tertiary Hospital

Abstract

Objective: In this study, it was aimed to describe rates, etiological agents of the secondary infections and its effect on clinical outcomes among hospitalized patients with COVID-19.
Materials and Methods: A retrospective comparative analysis of the characteristics of patients with and without secondary infection was carried out among 150 hospitalized adult patients with a confirmed diagnosis of COVID-19 via RT-PCR.
Results: Among included patients, 20 (13.3%) had at least one secondary infection. Secondary infection rate in ICU patients (72%) was significantly higher than patients in the general ward (1.6%) (p<0.001). The prevalence of ventilator-associated pneumonia (VAP) was 52% in ICU patients. The majority of 31 microorganisms isolated were gram negative bacteria. Overall, 147 (98%) patients received at least one antibiotic during their hospitalization. A significantly higher mortality rate was present in patients with secondary infection compared to those without.
Conclusion: Since the rate of secondary infection in hospitalized COVID-19 patients in the general ward is very low, we consider that empirical antibiotic therapy should not be initiated in these patients in accordance with the rational use of antibiotics. Besides, we recommend that multidrug-resistant bacteria be taken into account both in the empirical and targeted antimicrobial therapy of VAP infections. 

Keywords

• antibiotic use
• COVID-19
• secondary infections
• ventilator-associated pneumonia

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