Mortality Rate among Patients Mechanically Ventilated for COVID-19 Pneumonia in Association with Secondary Bacterial Infections

Bolest uzrokovana SARS-CoV-2 prvi se puta spominje krajem prosinca 2019., kada se opisuju prvi slučajevi atipične pneumonije u Wuhanu, Kina. Klinička slika COVIDA-19 raznolika je i varira od asimptomatskih slučajeva preko akutnog respiratornog distres sindroma do višestrukog organskog zatajenja uz upala pluća kao jednu od glavnih značajki COVIDA-19. Bakterijski patogeni često su izolirani u pacijenata s virusnim infekcijama kao uzročnici sekundarnih bakterijski infekcija zbog toga jer imunosni odgovor na akutnu virusnu infekciju dovodi do promjena u strukturi i funkcioniranju mikrobioma respiratornog i gastrointestinalnog sustava što ima za posljedicu modulaciju imunosnog odgovora. Sekundarna bakterijska infekcija može se razviti odmah po infekciji SARS-CoV-2 virusom ili nastupiti u fazi oporavka. Analizirani su podaci prikupljeni od 99 pacijenata koji su bili hospitalizirani na Odjelu intenzivnog liječenja Klinike za anesteziologiju, intenzivnu medicinu i liječenje boli KBC-a Rijeka. Većina ispitanika bila je muškog spola, njih 71.7% što je u skladu s podacima u ostalim istraživanjima koja su se bavila ovim pitanjem. Prosječna dob iznosila je 66.7 godina pa je tako nešto viša od one u referentim istraživanjima gdje iznosi 59.7 – 64.8 godina. Većina pacijenata razvila je sekundarnu bakterijsku infekciju, njih 80.8%. Postotak pacijenata koji su razvili sekundarnu bakterijsku infekciju varira od 5.9% do 83.3 % u dostupnim istraživanjima, ovisno o težini kliničke slike kojom su se prezentirali ispitivani pacijenti, dok su ispitanici u našem istraživanju bolovali od najtežeg oblika COVIDA-19 i bili dugotrajno mehanički ventilirani. Nije pronađena statistički značajna razlika u razvoju sekundarne bakterijske infekcije u ovisnosti o spolu niti dobi. Nije pronađena statistički značajna razlika u razvoju sekundarne bakterijske infekcije u ovisnosti o ishemijskoj bolesti srca, arterijskoj hipertenziji i šećernoj bolesti. U našem istraživanju, nije utvrđena statistički značajna razlika u smrtnosti između pacijenata koji su razvili sekundarnu bakterijsku infekciju u odnosu na pacijente koji nisu razvili sekundarnu bakterijsku infekciju.The disease caused by SARS-CoV-2 was first mentioned in late December 2019, when the first cases of atypical pneumonia were described in Wuhan, China. The clinical presentation of COVID-19 varies from asymptomatic cases and acute respiratory distress syndrome to multiple organic failure. However, atypical pneumonia is one of the main features of COVID-19. Bacterial pathogens are often isolated in patients with viral infections as causes of secondary bacterial infections because the immune response to acute viral infection leads to changes in the structure and function of the respiratory and gastrointestinal microbiome resulting in modulation of the immune response. Secondary bacterial infection can develop immediately after SARS-CoV-2 infection or occur in the recovery phase. Analyzed data was collected from 99 patients who were hospitalized in the Department of Anesthesiology, Intensive Medicine and Pain Treatment Clinic of Clinical Hospital Center Rijeka majority of patients were male, 71.7% of them, which is in line with data from other studies that addressed this issue. The average age was 66.7 years, which is slightly higher than in the reference surveys (59.7 – 64.8 years). Most patients have developed a secondary bacterial infection, 80.8% of them. The percentage of patients who developed secondary bacterial infection ranged from 5.9% to 83.3% in the available studies, depending on the severity of the clinical presentation of the subjects. Data used in our study is only from patients with most severe form of COVID-19 treated in Intensive Care Unit and long term mechanically ventilated. No statistically significant difference was found in the development of secondary bacterial infection depending on gender or age. No statistically significant difference was found in the development of secondary bacterial infection depending on arterial hypertension, ischemic heart disease or diabetes. In our study, no statistically significant difference in mortality was found between patients who developed secondary bacterial infection compared to those who didn’t developed secondary bacterial infection