COVID-19 HASTALARINDA SEKONDER ENFEKSİYONLAR VE LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ: ÜNİVERSİTE HASTANESİNDE YAPILAN RETROSPEKTİF BİR ÇALIŞMA

Öz

Sekonder enfeksiyonlar, COVID-19 ile hastaneye yatırılan hastalarda yüksek mortaliteye yol açan başlıca komplikasyonlar arasındadır. Bu çalışmada, COVID-19 hastalarında gelişen sekonder enfeksiyonların prevalansı, risk faktörleri, etiyolojik ajanları ve antimikrobiyal direnç paternlerinin belirlenmesi amaçlanmıştır. Çalışmaya 48 saat hastanede yattıktan sonra sekonder bakteriyel ve fungal enfeksiyon gelişen, COVID-19 PCR testi pozitif olan hastalar dahil edilmiştir. Hastaların klinik örneklerinden elde edilen bakteri ve mantar kültürlerinin sonuçları retrospektif olarak değerlendirilmiştir. Bu çalışmanın sonunda hastanede yatan 267 hastanın %16.1'inde (n=43) sekonder enfeksiyon geliştiği belirlenmiştir. Sekonder enfeksiyonlar erkeklerde (n=28, %65.1) kadınlara (n=15, %34.9) göre daha fazla saptanmıştır (p=0.024). Sekonder enfeksiyonu olan hastaların medyan yaşı (65.0 yıl) daha yüksek bulunmuştur (p<0.05). Sekonder enfeksiyonlu 43 hastanın %93'ünde (n=40) komorbidite saptanmıştır. Sekonder enfeksiyon gelişen hastaların 29'unun (%67.4) yoğun bakım ünitelerinde, 14'ünün (%32.6) servislerde tedavi gördüğü belirlenmiştir (p<0.001). Sekonder enfeksiyonların hastanede kalış süresini uzattığı (ortalama 25.5 gün) ve mortaliteyi artırdığı (n=16, %37.2) bulunmuştur (p<0.001). Etken ajan olarak tanımlanan ilk üç mikroorganizma, metisiline dirençli koagülaz negatif stafilokoklar (n=21, %16.3), Acinetobacter baumannii (n=19, %14.7) ve Candida albicans’tır (n=14, %10.9). Acinetobacter baumannii izolatlarının karbapenem direnç oranları %94.7 saptanmıştır. Koagülaz negatif stafilokokların %100'ünde metisilin direnci bulunurken vankomisin, teikoplanin ve linezolid direnci saptanmamıştır. C. albicans (%10.9) izolatlarında test edilen antifungal ajanlara karşı direnç bulunmamıştır. Sekonder enfeksiyonlar arasında özellikle pnömoni (n=25, %36.3), kan dolaşımı enfeksiyonları (n=19, %27.6) ve idrar yolu (n=18, %26.1) enfeksiyonları ilk sırada yer almıştır. COVID-19 ile ilişkili olarak gelişen sekonder enfeksiyonların ve risk faktörlerinin saptanması, etken mikroorganizmaların tanımlanması ve antimikrobiyal direnç paternlerinin belirlenmesi hastalığın prognozu, enfeksiyon kontrolü ve antimikrobiyal yönetimi açısından oldukça önemlidir.

Anahtar Kelimeler

• COVID-19
• patojen
• risk faktörleri
• sekonder enfeksiyon
• Türkiye

Secondary Infections in Patients with COVID-19 and Review of the Literature: A Retrospective Study Conducted at a University Hospital

Öz

Secondary infections are among the main complications leading to high mortality in patients hospitalized with COVID-19. This study aimed to determine the prevalence, risk factors, etiological agents and antimicrobial resistance patterns of secondary infections that developed in patients with COVID-19. In the study, patients with a positive COVID-19 PCR test who developed secondary bacterial and fungal infections after 48 hours of hospitalization were included. The results of the bacterial and fungal cultures obtained from the clinical samples of the patients were retrospectively evaluated. At the end of this study, it was determined that 16.1% (n=43) of 267 hospitalized patients developed secondary infections. Secondary infections were detected more in males (n=28, 65.1%) than females (n=15, 34.9%) (p=0.024). The median age (65.0 years) of patients with secondary infection was found to be higher (p<0.05). Comorbidity was detected in 93% (n=40) of 43 patients with secondary infections. It was found that 29 (67.4%) of the patients who developed secondary infection were treated in ICU and 14 (32.6%) were treated in the services (p<0.001). Secondary infections found to prolong hospital stay (median 25.5 days) and increase mortality (n=16, 37.2%) (p<0.001). The first three microorganisms identified as causative agents were methicillin-resistant coagulase-negative staphylococci (n=21, 16.3%), Acinetobacter baumannii (n=19, 14.7%) and Candida albicans (n=14, 10.9%). Carbapenem resistance rates of Acinetobacter baumannii isolates were 94.7%. While methicillin resistance was found in 100% of coagulase negative staphylococci, no resistance was found to vancomycin, teicoplanin and linezolid. No resistance was found to the tested antifungal agents in C. albicans (10.9%) isolates. Among secondary infections, especially pneumonia (n=25, 36.3%), bloodstream infections (n=19, 27.6%) and urinary tract infections (n=18, 26.1%) ranked first. Detection of secondary infections and risk factors associated with COVID-19, identification of causative microorganisms and determination of antimicrobial resistance patterns are very important in terms of prognosis, infection control and antimicrobial management of the disease.

Anahtar Kelimeler

• COVID-19
• pathogen
• risc factors
• secondary infection
• Turkey

Kaynakça

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