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Risk Factors Associated with Hospital-Acquired Infections for COVID-19 Patients in ICU
18 Pages Posted: 9 Apr 2020More...
Background: COVID-19 is an emerging global threat. The severe patients were given supportive treatment in the ICU where is the primary site for the hospital-acquired infections (HAIs). HAIs are an increasing problem resulting in adverse effects for hospitalized patients. Nevertheless, the impact of HAIs on the COVID-19 patients in ICU and its consequences has not been studied. This study is to investigate the HAI rates, impact factors, consequences and bacteria etiology of HAIs for the severe COVID-19 patients in ICU, so as to raise the awareness of the hospital infection control.
Methods: In this retrospective cohort study, we screened 62 severe COVID-19 pneumonia patients in the ICU from January 3 rd to March 1 st , 2020 at Zhongnan Hospital of Wuhan University. Demographic and clinical data were collected. The HAI was according to the standard ECDC criteria. The differences of related factors (including demographic characters, onset symptoms, comorbidities, respiratory support, laboratory findings, mortality, hospital stay and costs) between HAI and Non-HAI cohorts were analyzed by Mann–Whitney U tests and t-tests. The independent risk factors of HAIs were performed with LASSO Logistic regression and Multivariable logistic regression.
Findings: The incidence of HAI for the severe COVID-19 patients in ICU were 45.2%. Compared with the patients in Non-HAI group, higher frequency of utilization of invasive ventilation (IV) ( p <0.001), decreased platelet count ( p =0.009) and SpO2 ( p =0.015), prolonged prothrombin time ( p =0.009), higher level of lactate dehydrogenase (LDH) ( p =0.047), aspartate aminotransferase (AST) ( p =0.013), C-reactive protein ( p =0.029), IL-6 ( p =0.035), hospitalization stay ( p =0.010), ICU stay ( p =0.020) and costs ( p <0.001) were observed in HAI group. Although the death rate of HAI group was higher than that in Non-HAI group (32.1% vs. 14.7%), there was no significant difference of mortality between the two groups. The independent risk factors for HAIs were prothrombin time (PT)(OR=2.0), AST (OR=1.032), invasive ventilation (NIV vs IV, OR=0.026), SpO2 (OR=0.884) and length of ICU (OR=1.239). Among these substantial factors, PT and AST were the novel independent risk factors for HAI. Multidrug-resistant Acinetobacter baumannii (46%) was the most common strain isolated from patients in the HAI group and the lower respiratory tract (61%) was the most common place for nosocomial infection.
Interpretation: We found that PT, AST, IV, SpO2 and ICU stay were the independent risk factors for HAI for the severe COVID-19 patients. The monitoring and prevention methods targeting these factors of HAI should be developed to control the occurrence of nosocomial infection and to reduce the hospitalization time and costs.
Funding Statement: None.
Declaration of Interests: All authors have no interest conflicts in this study.
Ethics Approval Statement: This clinical study was approved by the ethics committee of Zhongnan Hospital of Wuhan University.
Keywords: COVID-19, hospital-acquired infection, ICU, prothrombin time, aspartate aminotransferase, invasive ventilation, SpO2, ICU Stay
Suggested Citation: Suggested Citation