Araştırma Makalesi
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COVID-19 Hastalarında Ventilatörle İlişkili Pnömoni Risk Faktörleri ve Patojenlerin Değerlendirilmesi: Retrospektif Bir Çalışma

Yıl 2023, Cilt: 56 Sayı: 2, 70 - 74, 30.09.2023
https://doi.org/10.20492/aeahtd.1202913

Öz

Amaç: COVID-19 Pandemisi esnasında yoğun bakımlarda takip edilen hastaların çoğunda mekanik ventilasyon gerekliliği ortaya çıkmıştır. Bu çalışmada yoğun bakım ünitelerindeki COVID-19 hastalarında ventilatör ilişkili pnömonilerin risk faktörlerinin, sıklığının ve etkenlerinin incelenmesi amaçlanmıştır.

Yöntemler: Bu çalışma retrospektif bir tasarıma sahiptir ve bir eğitim araştırma hastanesinin 3. Basamak yoğun bakımlarında takip edilen COVID-19 hastaları arasında yapılmıştır. Çalışmaya Mart 2020 ile 1 Ocak 2021 arasında 3. Basamak yoğun bakımlarda entübe olarak takip edilen on sekiz yaşından büyük COVID-19 hastaları dahil edildi. Hasta dosyalarından endotrakeal aspirat kültürlerindeki üremeler, enfeksiyöz mikroorganizmalar ve antibiyotik duyarlılıkları gibi mikrobiyolojik veriler toplandı. Ventilatör ilişkili pnömonide etkili olan risk faktörlerini belirlemek için tek değişkenli ve çok değişkenli ikili Lojistik Regresyon analizi kullanıldı.

Bulgular: Hastaların %52.9 (108)’unda ventilatör ilişkili pnömoni görüldü ve endotrakeal aspirat kültürlerindeki üreme ile doğrulandı. Kültürde üreme görülen hastaların hastane yatış (17.56±14.09)(gün) ve entübe takip süreleri (14.55±11.66)(gün) üreme görülmeyen hastaların hastane yatış (9.74±6.01) ve entübe takip (7.12±4.32) sürelerinden anlamlı yüksek idi (sırasıyla, P<0.001, P<0.001).

Sonuç: Sonuç olarak, COVID-19 pandemisinde entübe yoğun bakım hastalarında ventilatör ilişkili pnömonilerin irdelendiği bu çalışmada en önemli prediktif faktörün mekanik ventilasyon süresi olduğu bulundu. Çalışmada en sık etkenin Acinetobacter baumannii olduğu tespit edildi.

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Kaynakça

  • 1. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81.
  • 2. Vincent JL, Sakr Y, Singer M, et al. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. JAMA. 2020;323(15):1478-87.
  • 3. Hunter JD. Ventilator associated pneumonia. BMJ. 2012;344:e3325.
  • 4. Lima WG, Brito JCM, da Cruz Nizer WS. Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii in patients with COVID-19: Two problems, one solution? Med Hypotheses. 2020;144:110139.
  • 5. Bartoletti M, Pascale R, Cricca M, et al. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study. Clin Infect Dis. 2021;73(11):e3606-e3614.
  • 6. Gregoire E, Pirotte BF, Moerman F, et al. Incidence and Risk Factors of COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit-A Monocentric Retrospective Observational Study. Pathogens. 2021;10(11):1370.
  • 7. Martin-Loeches I, Povoa P, Rodríguez A, et al. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med. 2015;3(11):859-68.
  • 8. Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. 9. Blonz G, Kouatchet A, Chudeau N, et al. Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: a multicenter retrospective study in 188 patients in an un-inundated French region. Crit Care. 2021;25(1):72.
  • 10. Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care. 2021;25(1):25.
  • 11. Llitjos JF, Bredin S, Lascarrou JB, et al. Increased susceptibility to intensive care unit-acquired pneumonia in severe COVID-19 patients: a multicentre retrospective cohort study. Ann Intensive Care. 2021;11(1):20.
  • 12. Razazi K, Arrestier R, Haudebourg AF, et al. Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease. Crit Care. 2020;24(1):699.
  • 13. Luyt CE, Sahnoun T, Gautier M, et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Ann Intensive Care. 2020;10(1):158.
  • 14. Giacobbe DR, Battaglini D, Enrile EM, et al. Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study. J Clin Med. 2021;10(4):555.
  • 15. Ippolito M, Misseri G, Catalisano G, et al. Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis. Antibiotics (Basel). 2021;10(5):545.
  • 16. Jamilloux Y, Henry T, Belot A, et al. Should we stimulate or suppress immune responses in COVID-19? Cytokine and anti-cytokine interventions. Autoimmun Rev. 2020;19(7):102567.
  • 17. Wang F, Nie J, Wang H, et al. Characteristics of Peripheral Lymphocyte Subset Alteration in COVID-19 Pneumonia. J Infect Dis. 2020;221(11):1762-69.
  • 18. Rendeiro AF, Ravichandran H, Bram Y, et al. The spatial landscape of lung pathology during COVID-19 progression. Nature. 2021;593(7860):564-569.
  • 19. Fadel R, Morrison AR, Vahia A, et al. Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19. Clin Infect Dis. 2020;71(16):2114-20.
  • 20. Mikulska M, Nicolini LA, Signori A, et al. Tocilizumab and steroid treatment in patients with COVID-19 pneumonia. PLoS One. 2020;15(8):e0237831
  • 21. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704.
  • 22. Russo A, Gavaruzzi F, Ceccarelli G, et al. Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit. Infection. 2022;50(1):83-92.
  • 23 Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(3):267-276.
  • 24. Rollas K, Ersan G, Emgin O, et al. Evaluation of Microorganisms Isolated from Endotracheal Aspirate Cultures in Patients with and without COVID-19 in the Intensive Care Unit: Single-Centre Retrospective Analysis. J Crit Intensive Care 2022;13:66−72.
  • 25. Rouzé A, Martin-Loeches I, Povoa P, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med. 2021;47(2):188-198.
  • 26. Rangel K, Chagas TPG, De-Simone SG. Acinetobacter baumannii Infections in Times of COVID-19 Pandemic. Pathogens. 2021;10(8):1006.
  • 27. Ripa M, Galli L, Poli A, et al. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors. Clin Microbiol Infect. 2021 Mar;27(3):451-457.
  • 28. Montoya A, Schildhouse R, Goyal A, et al. How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis. Am J Infect Control. 2019 Jun;47(6):693-703.

Evaluation of Ventilator-Associated Pneumonia Risk Factors and Pathogens in COVID-19 Patients: A Retrospective Study

Yıl 2023, Cilt: 56 Sayı: 2, 70 - 74, 30.09.2023
https://doi.org/10.20492/aeahtd.1202913

Öz

Objective: Many patients followed in intensive care units during the COVID-19 pandemic required mechanical ventilation. In the present study, the purpose was to examine the risk factors, frequency, and causative pathogens of ventilator-associated pneumonia in COVID-19 patients in intensive care units.

Material and Method: The study had a retrospective study design and was conducted among COVID-19 patients followed in the tertiary intensive care units of a training and research hospital. COVID-19 patients, who were older than eighteen years, and intubated in the tertiary intensive care units between March 2020 and January 1, 2021, were included in the present study. Microbiological data such as reproductions in endotracheal aspirate cultures, infectious microorganisms, and antibiotic susceptibility were collected from the patient files. Univariate and Multivariate Binary Logistic Regression analysis were used to determine the risk factors effective in ventilator-associated pneumonia.

Results: Ventilator-associated pneumonia was observed in 52.9% (108) of patients, which was confirmed by growth in endotracheal aspirate cultures. The hospitalization (17.56±14.09) and intubated follow-up times (14.55±11.66)(day) of the patients who had culture growth were significantly higher than the hospitalization (9.74±6.01) and intubated follow-up (7.12±4.32)(day) times of the patients without growth (P<0.001, P<0.001, respectively).

Conclusions: In conclusion, in the present study, where ventilator-associated pneumonia evaluations were made in intensive care patients intubated during the COVID-19 pandemic, it was found that the most important predictive factor was the duration of mechanical ventilation. Acinetobacter baumannii was detected to be the most common causative pathogen in the study.

Proje Numarası

yok

Kaynakça

  • 1. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81.
  • 2. Vincent JL, Sakr Y, Singer M, et al. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. JAMA. 2020;323(15):1478-87.
  • 3. Hunter JD. Ventilator associated pneumonia. BMJ. 2012;344:e3325.
  • 4. Lima WG, Brito JCM, da Cruz Nizer WS. Ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii in patients with COVID-19: Two problems, one solution? Med Hypotheses. 2020;144:110139.
  • 5. Bartoletti M, Pascale R, Cricca M, et al. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study. Clin Infect Dis. 2021;73(11):e3606-e3614.
  • 6. Gregoire E, Pirotte BF, Moerman F, et al. Incidence and Risk Factors of COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit-A Monocentric Retrospective Observational Study. Pathogens. 2021;10(11):1370.
  • 7. Martin-Loeches I, Povoa P, Rodríguez A, et al. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med. 2015;3(11):859-68.
  • 8. Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. 9. Blonz G, Kouatchet A, Chudeau N, et al. Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: a multicenter retrospective study in 188 patients in an un-inundated French region. Crit Care. 2021;25(1):72.
  • 10. Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care. 2021;25(1):25.
  • 11. Llitjos JF, Bredin S, Lascarrou JB, et al. Increased susceptibility to intensive care unit-acquired pneumonia in severe COVID-19 patients: a multicentre retrospective cohort study. Ann Intensive Care. 2021;11(1):20.
  • 12. Razazi K, Arrestier R, Haudebourg AF, et al. Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease. Crit Care. 2020;24(1):699.
  • 13. Luyt CE, Sahnoun T, Gautier M, et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Ann Intensive Care. 2020;10(1):158.
  • 14. Giacobbe DR, Battaglini D, Enrile EM, et al. Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study. J Clin Med. 2021;10(4):555.
  • 15. Ippolito M, Misseri G, Catalisano G, et al. Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis. Antibiotics (Basel). 2021;10(5):545.
  • 16. Jamilloux Y, Henry T, Belot A, et al. Should we stimulate or suppress immune responses in COVID-19? Cytokine and anti-cytokine interventions. Autoimmun Rev. 2020;19(7):102567.
  • 17. Wang F, Nie J, Wang H, et al. Characteristics of Peripheral Lymphocyte Subset Alteration in COVID-19 Pneumonia. J Infect Dis. 2020;221(11):1762-69.
  • 18. Rendeiro AF, Ravichandran H, Bram Y, et al. The spatial landscape of lung pathology during COVID-19 progression. Nature. 2021;593(7860):564-569.
  • 19. Fadel R, Morrison AR, Vahia A, et al. Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19. Clin Infect Dis. 2020;71(16):2114-20.
  • 20. Mikulska M, Nicolini LA, Signori A, et al. Tocilizumab and steroid treatment in patients with COVID-19 pneumonia. PLoS One. 2020;15(8):e0237831
  • 21. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704.
  • 22. Russo A, Gavaruzzi F, Ceccarelli G, et al. Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit. Infection. 2022;50(1):83-92.
  • 23 Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(3):267-276.
  • 24. Rollas K, Ersan G, Emgin O, et al. Evaluation of Microorganisms Isolated from Endotracheal Aspirate Cultures in Patients with and without COVID-19 in the Intensive Care Unit: Single-Centre Retrospective Analysis. J Crit Intensive Care 2022;13:66−72.
  • 25. Rouzé A, Martin-Loeches I, Povoa P, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med. 2021;47(2):188-198.
  • 26. Rangel K, Chagas TPG, De-Simone SG. Acinetobacter baumannii Infections in Times of COVID-19 Pandemic. Pathogens. 2021;10(8):1006.
  • 27. Ripa M, Galli L, Poli A, et al. Secondary infections in patients hospitalized with COVID-19: incidence and predictive factors. Clin Microbiol Infect. 2021 Mar;27(3):451-457.
  • 28. Montoya A, Schildhouse R, Goyal A, et al. How often are health care personnel hands colonized with multidrug- resistant organisms? A systematic review and meta-analysis. Am J Infect Control. 2019 Jun;47(6):693-703.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Saliha Yarımoglu 0000-0001-7081-9474

Rafet Yarımoglu 0000-0002-1189-8448

Proje Numarası yok
Yayımlanma Tarihi 30 Eylül 2023
Gönderilme Tarihi 11 Kasım 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 56 Sayı: 2

Kaynak Göster

AMA Yarımoglu S, Yarımoglu R. Evaluation of Ventilator-Associated Pneumonia Risk Factors and Pathogens in COVID-19 Patients: A Retrospective Study. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. Eylül 2023;56(2):70-74. doi:10.20492/aeahtd.1202913