EFFECT OF SUPERINFECTION ON TREATMENT OUTCOME IN PATIENTS WITH COVID-19 PNEUMONIA IN RESPIRATORY CENTER KBC OSIJEK

Cilj istraživanja: Ispitati učestalost nastanka superinfekcije kod COVID-19 mehanički ventiliranih bolesnika te ispitati postoje li razlike u dobi, spolu i komorbiditetima između skupine bolesnika bez superinfekcije i sa superinfekcijom. Ispitati razliku duljine boravka i ishoda liječenja između dviju skupina COVID-19 bolesnika. Nacrt studije: presječno istraživanje. Ispitanici i metode: U istraživanje je uključeno 315 SARS-CoV-2 pozitivnih bolesnika hospitaliziranih u Respiracijski centar KBC Osijek u 2020. godini. Podijeljeni su u skupinu bolesnika bez superinfekcije i sa superinfekcijom na temelju patološke mikrobiološke kulture ili vrijednosti prokalcitonina > 1,00 μg/L. Prikupljeni su podatci iz povijesti bolesti i terapijskih listi te su uspoređene razlike između dviju skupina. Korištene statističke metode su: Hi-kvadrat test, Mann Whitney U test i Wilcoxon test. Rezultati: Medijan dobi svih bolesnika je 69 godina, a najučestaliji komorbiditet je hipertenzija (80,3 %). Superinfekciju je razvilo 70,2 % (221) bolesnika i to 37,1 % bakterijemiju, 35,6 % infekciju respiratornog trakta, a 8,3 % urinarnog infekciju. Bolesnici sa superinfekcijom su proveli značajno više dana u Respiracijskom centru, 95,9 % ih je intubirano i imali su više dana mehaničke ventilacije te značajno veću smrtnost (87,3 %). Najučestaliji uzročnik superinfekcije je Acinetobacter baumanii izoliran kod 51,2 % (124) bolesnika. Bolesnici sa razvijenom superinfekcijom su imali značajno više vrijednosti leukocita, CRP-a i PCT-a pri prijemu u Respiracijski centar. Zaključak: Bolesnici sa razvijenom superinfekcijom su značajno češće imali smrtni ishod, češće su intubirani i proveli su značajno više dana na mehaničkoj ventilaciji i u Respiracijskom centru.Objectives: The aim of this study was to research the prevalence of superinfections in mechanically ventilated COVID-19 patients and to examine the difference in age, sex and comorbidities between patients without superinfection and with superinfection. The aim was to examine the length of ICU stay and outcomes among the two groups of COVID-19 patients. Study Design: Cross-sectional study Participants and Methods: The study included 315 SARS-CoV-2 positive patients hospitalized at Intensive care unit of the Clinical Hospital Centre Osijek during 2020. The patients were divided into group of patients without or with superinfection depending on the result of positive microbiology specimen or PCT levels of > 1,00 μg/L. The data were obtained from the disease history analysis and therapeutic lists and the differences between two groups were analysed. Statistical analysis was performed using Chi-square test, Mann Whitney U test and Wilcoxon test. Results: The median age of patients was 69 years and hypertension was the most frequent comorbidity (80,3 %). Overall, 70,2 % (221) of patients developed superinfection, 37,1 % blood-stream infection, 35,6 % respiratory infection and 8,3 % urinary infection. Patients with secondary infections had increased length of ICU stay, increased mortality rate (87,3 %) and 95,2 % of them were intubated and required prolonged invasive mechanical ventilation. Acinetobacter baumanii was the most commonly isolated pathogen and was isolated in 51,2 % (124) of patients. Patients who developed superinfection had significantly higher levels of leukocytes, CRP and PCT at ICU admission. Conclusion: COVID-19 patients who have developed superinfection had significantly higher mortality rates, were more frequently intubated, required prolonged invasive mechanical ventilation and longer ICU stay