Ağır Covid-19’da bakteriyel pnömoni riski artıyor mu?

Öz

Amaç: Yoğun bakım ünitesinde takip edilen hastalarda görülen bakteriyel pnömoni etkenlerinin COVID-19 öncesi ve sonrası dönemlerdeki farklılıkların incelenmesi amaçlandı. Gereç ve Yöntem: COVID-19 pandemisi öncesi üç aylık dönemde (Grup 1) ve pandeminin üç aylık döneminde (Grup 2) YBÜ’de takip edilen hastaların; demografik özellikleri, mekanik ventilasyon (MV) ihtiyaçları ve MV’nin ilk günü ve 48. saat sonrası ile yedinci günü arasındaki dönemde alınan derin trakeal aspirat (DTA) kültürleri geriye dönük incelendi. Bu iki gruba ait veriler SPSS Windows 23.0 paket programı ile analiz edildi. Bulgular: Dahil edilen hasta sayısı Grup 1’de 101, Grup 2’de 192 idi. Yaş ortalaması ve yattığı gün sayısı incelendiğinde iki grup benzerdi. MV ihtiyacı gelişen hasta sayısı Grup 1’de 69 (%68.3), Grup 2’de 130 (%69.7) idi. MV’nin birinci gününde pnömoni şüphesi ile DTA kültürü alınan hasta sayısı Grup 1 ve 2’de sırasıyla 45(%65.2) ve 49 (%37.7) idi. Bu hastaların kültürlerinde bakteri izole edilme oranları ise %33.3 ve %14.3 idi. Kültürde bakteri izole edilen hastaların, MV ihtiyacı olanlara oranı Grup 1’de %21.7 iken, Grup 2’de %5.3 idi. MV’nin 48. saati ile yedinci günü arasındaki dönemde pnömoni şüphesi ile DTA kültürü alınan hasta sayısı Grup 1’de 20 (%29.4), Grup 2’de 39 (%30.9) idi. Alınan bu kültürlerde bakteri izole edilme oranı sırasıyla %65 ve %71.8 olarak belirlendi. Bakteri izole edilen hastaların, tüm MV ihtiyacı olanlara oranı Grup 1’de %19.1 iken, Grup 2’de %22.2 idi. Sonuç: Ağır COVID-19 hastalarında bakteriyel koenfeksiyon riski YBÜ'deki diğer hastalara benzerdir. Yoğun bakım ünitelerinde bakteriyel pnömoni açısından hastalara yaklaşım, COVID-19 olmayan hastalara benzer olmalıdır.

Anahtar Kelimeler

• Ağır Covid-19
• bakteriyel pnömoni
• yoğun bakım
• koronavirüs

Does the risk of bacterial pneumonia increase in severe Covid-19?

Öz

Aim: We aimed to reveal the difference in the distribution of bacterial agents causing pneumonia in patients followed in intensive care units (ICUs) in the pre- and post-COVID-19 periods. Material and Methods: Deep tracheal aspirate (DTA) cultures in the ICUs in the three-month period before the COVID-19 pandemic (Group 1) and in the three-month period of the COVID-19 pandemic (Group 2) were analyzed. The demographic characteristics of the patients, their mechanical ventilation (MV) status, and DTA cultures taken on the first day and between 48th hours to the 7th day of the MV were analyzed. The data were analyzed using the SPSS for Windows 23.0 package program. Results: The number of patients was 101 in Group-1 and 192 in Group-2. Mean age and the mean length of stay were similar. The number of the patients on MV were 69 (68.3%) and 130 (69.7%) in group-1 and 2, respectively. The ratio of patients who were performed DTA due to bacterial co-infection suspicion on the first day of MV was 65.2% and 37.7% in group-1 and 2, respectively. The culture positivity rate was 33.3% and 14.3% in group-1 and 2, respectively. The rate of patients with culture positivity among patients who needed MV was 21.7% in group 1, and 5.3% in group 2. The number of patients who were performed DTA due to bacterial co-infection suspicion between 48th hours and 7th day of MV was 20 (29.4%) and 39 (30.9%) in group-1 and 2, respectively. The culture positivity in group-1 and 2 was 65% and 71.8%, respectively. The rate of patients with culture positivity among patients who needed MV was 19.1% in group 1, and 22.2% in group 2. Conclusion: The risk of bacterial co-infection among severe COVID-19 patients was similar to the other patients in ICUs. In terms of bacterial pneumonia, the approach to patients followed in the ICU for COVID-19 should be similar to the pre-COVID-19 pandemic period.

Anahtar Kelimeler

• Severe Covid-19
• bacterial pneumonia
• intensive care
• coronavirus

Kaynakça

1. 1. Shah NS, Greenberg JA, McNulty MC, et al. Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013-14. J Clin Virol. 2016;80:12-19. doi:10.1016/j.jcv.2016.04.008.
2. 2. Rice TW, Rubinson L, Uyeki TM, et al. Critical illness from 2009 pandemic influenza A virus and bacterial coinfection in the United States. Crit Care Med. 2012;40(5):1487-1498. doi:10.1097/CCM.0b013e3182416f23.
3. 3. Esper FP, Spahlinger T, Zhou L. Rate and influence of respiratory virus co-infection on pandemic (H1N1) influenza disease. J Infect. 2011;63(4):260-266. doi:10.1016/j.jinf.2011.04.004.
4. 4. Klein EY, Monteforte B, Gupta A, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2016;10(5):394-403. doi:10.1111/irv.12398.
5. 5. Huttner BD, Catho G, Pano-Pardo JR, Pulcini C, Schouten J. COVID-19: don't neglect antimicrobial stewardship principles!. Clin Microbiol Infect. 2020;26(7):808-810. doi:10.1016/j.cmi.2020.04.024.
6. 6. Cox MJ, Loman N, Bogaert D, O'Grady J. Co-infections: potentially lethal and unexplored in COVID-19. Lancet Microbe. 2020;1(1):e11. doi:10.1016/S2666-5247(20)30009-4.
7. 7. Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12):1622-1629. doi:10.1016/j.cmi.2020.07.016.
8. 8. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] [published correction appears in Lancet. 2020 Mar 28;395(10229):1038]. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3.

9. 9. Mirzaei R, Goodarzi P, Asadi M, et al. Bacterial co-infections with SARS-CoV-2. IUBMB Life. 2020;72(10):2097-2111. doi:10.1002/iub.2356.
10. 10. Sieswerda E, de Boer MGJ, Bonten MMJ, et al. Recommendations for antibacterial therapy in adults with COVID-19 - an