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COVID-19 increased the risk of ICU-acquired bloodstream infections: a case-cohort study from the multicentric OUTCOMEREA network.

新型冠状病毒肺炎增加ICU获得性血流感染的风险: 一项来自多中心OUTCOMEREA网络的病例队列研究。

  • 影响因子:4.19
  • DOI:10.1007/s00134-021-06346-w
  • 作者列表:"Buetti N","Ruckly S","de Montmollin E","Reignier J","Terzi N","Cohen Y","Siami S","Dupuis C","Timsit JF
  • 发表时间:2021-02-01
Abstract

PURPOSE:The primary objective of this study was to investigate the risk of ICU bloodstream infection (BSI) in critically ill COVID-19 patients compared to non-COVID-19 patients. Subsequently, we performed secondary analyses in order to explain the observed results. METHODS:We conducted a matched case-cohort study, based on prospectively collected data from a large ICU cohort in France. Critically ill COVID-19 patients were matched with similar non-COVID-19 patients. ICU-BSI was defined by an infection onset occurring > 48 h after ICU admission. We estimated the effect of COVID-19 on the probability to develop an ICU-BSI using proportional subdistribution hazards models. RESULTS:We identified 321 COVID-19 patients and 1029 eligible controls in 6 ICUs. Finally, 235 COVID-19 patients were matched with 235 non-COVID-19 patients. We observed 43 ICU-BSIs, 35 (14.9%) in the COVID-19 group and 8 (3.4%) in the non-COVID-19 group (p ≤ 0.0001), respectively. ICU-BSIs of COVID-19 patients were more frequently of unknown source (47.4%). COVID-19 patients had an increased probability to develop ICU-BSI, especially after 7 days of ICU admission. Using proportional subdistribution hazards models, COVID-19 increased the daily risk to develop ICU-BSI (sHR 4.50, 95% CI 1.82-11.16, p = 0.0012). Among COVID-19 patients (n = 235), a significantly increased risk for ICU-BSI was detected in patients who received tocilizumab or anakinra (sHR 3.20, 95% CI 1.31-7.81, p = 0.011) but not corticosteroids. CONCLUSIONS:Using prospectively collected multicentric data, we showed that the ICU-BSI risk was higher for COVID-19 than non-COVID-19 critically ill patients after seven days of ICU stay. Clinicians should be particularly careful on late ICU-BSIs in COVID-19 patients. Tocilizumab or anakinra may increase the ICU-BSI risk.

摘要

目的: 本研究的主要目的是调查新型冠状病毒肺炎例危重患者与非新型冠状病毒肺炎例患者相比,ICU血流感染 (BSI) 的风险。随后,我们进行了二次分析以解释观察到的结果。 方法: 我们进行了一项匹配的病例队列研究,该研究基于前瞻性收集的来自法国大型ICU队列的数据。危重症新型冠状病毒肺炎例患者与相似的非新型冠状病毒肺炎例患者相匹配。ICU-BSI定义为ICU入院后> 48 h发生感染。我们使用比例分布风险模型估计了新型冠状病毒肺炎对发生ICU-BSI概率的影响。 结果: 我们在6个icu中确定了321例新型冠状病毒肺炎患者和1029例合格对照。最后,235名新型冠状病毒肺炎患者与235名非新型冠状病毒肺炎患者匹配。我们观察到43例ICU-BSIs,新型冠状病毒肺炎组35例 (14.9%),非新型冠状病毒肺炎组8例 (3.4%) (p ≤≤ 0.0001)。新型冠状病毒肺炎例患者的ICU-bsi更常见 (47.4%)。新型冠状病毒肺炎的患者发生ICU-BSI的概率增加,特别是在ICU入院7天后。使用比例子分布风险模型,新型冠状病毒肺炎增加了发生ICU-BSI的每日风险 (sHR 4.50,95% CI 1.82-11.16,p   =   0.0012)。在新型冠状病毒肺炎例患者 (n   =   235) 中,在接受托珠单抗或anakinra (sHR 3.20,95% CI 1.31-7.81,p   =   0.011) 但未接受皮质类固醇的患者中检测到ICU-BSI风险显著增加。 结论: 使用前瞻性收集的多中心数据,我们显示ICU住院7天后,新型冠状病毒肺炎的ICU-BSI风险高于非新型冠状病毒肺炎重症患者。临床医生应特别小心新型冠状病毒肺炎例患者的晚期ICU-BSIs。托珠单抗或anakinra可能会增加ICU-BSI风险。

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影响因子:2.68
发表时间:2021-02-01
DOI:10.1080/14656566.2020.1814255
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DOI:10.1007/s11033-021-06299-9
作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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