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Infeções secundárias em doentes com COVID-19
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Resumo(s)
Infeções secundárias são comumente observadas em consequência de pneumonias virais
levando a complicações clínicas adicionais e ao aumento da morbimortalidade.
Considerando o impacto mundial da infeção pelo vírus SARS-CoV-2 (Severe Acute Respiratory
Syndrome Coronavirus-2) e da respetiva doença, COVID-19 (coronavirus disease 2019), torna-se imperativo aumentar o conhecimento sobre as infeções secundárias nestes doentes.
Este trabalho apresenta uma revisão sobre a COVID-19 e de que forma esta torna os
doentes mais suscetíveis a desenvolver infeções secundárias. Foram analisados estudos
observacionais de doentes hospitalizados com COVID-19, avaliando a incidência de infeções
secundárias, bem como os fatores que favorecem o seu desenvolvimento. Particularmente,
foram revistos dados clínicos e a literatura sobre infeções bacterianas secundárias, analisando-se a frequência, os microrganismos responsáveis e os mecanismos de desenvolvimento deste
tipo de infeções. Analisaram-se e apresentam-se algumas medidas de controlo e gestão de
infeções secundárias que devem ser adotadas, incluindo a terapêutica antibiótica utilizada.
A COVID-19 é uma doença complexa, marcada, em certos casos, por dano pulmonar,
inflamação exacerbada e desenvolvimento subsequente de um estado de imunossupressão. Este
quadro, associado ao tipo de cuidados médicos necessários, tornam os doentes mais suscetíveis
a contrair infeções secundárias. O tempo médio que os doentes demoram a desenvolver infeções
secundárias após admissão hospitalar foi estimado em 11,6 dias, observando-se taxas de infeção
entre 4,3 e 15%, associadas a pior prognóstico, maior letalidade e mortalidade. Entre os
principais agentes causadores encontram-se as bactérias, nomeadamente Pseudomonas
aeruginosa, Staphylococcus aureus, Escherichia coli e Klebsiella pneumoniae, e, com menor
frequência, infeções de origem fúngica por Aspergillus spp. e Candida spp., sendo pouco
expressivas infeções secundárias por vírus. A maioria dos doentes hospitalizados receberam
antibioterapia (67 – 100%), muitos em profilaxia, contrariamente ao recomendado.
Doenças pulmonares causados por coronavírus vão constituir um desafio social e clínico
por muitos anos, sendo por isso importante compreender não só a infeção primária como as
infeções secundárias.
Secondary infections are commonly consequence of viral pneumonias, leading to additional clinical complications and increased morbidity and mortality by the disease. With the worldwide impact of infection by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) and the disease COVID-19 (coronavirus disease 2019), it is imperative to increase knowledge about secondary infections in these patients. The aim of this study was to make a review about COVID-19 and how it makes patients more susceptible to developing secondary infections. The incidence of secondary infections was analysed by observational studies of hospitalized patients, as well as the factors favouring their development. It was reviewed clinical data and literature about secondary bacterial infections in particular, the frequency, the main responsible microorganisms and the mechanisms of development for this infection type. Measures that should be adopted for the control and management of secondary infections, including the antibiotic therapy used, were analysed and presented. COVID-19 is a complex disease, that in certain cases cause lung damage, exacerbated inflammation and subsequently development of immunosuppression, leading to a more complex medical care. All these factors combined make these patients more susceptible to acquire secondary infections. The average time to develop secondary infections after the hospital admission was estimated at 11.6 days, with infection rates ranging between 4.3 and 15%, and these cases are associated with worse prognosis, higher lethality and mortality. The infections were often bacterial, especially caused by Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, less frequent are fungal infections by Aspergillus spp. and Candida spp., and secondary virus infections were not expressive. Most patients were treated with antibiotic (67 – 100%), many on prophylaxis, contrary to recommended. Coronavirus pulmonary diseases will be a social and clinical challenge for many years, that is why it is important to understand the primary and secondary infections.
Secondary infections are commonly consequence of viral pneumonias, leading to additional clinical complications and increased morbidity and mortality by the disease. With the worldwide impact of infection by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) and the disease COVID-19 (coronavirus disease 2019), it is imperative to increase knowledge about secondary infections in these patients. The aim of this study was to make a review about COVID-19 and how it makes patients more susceptible to developing secondary infections. The incidence of secondary infections was analysed by observational studies of hospitalized patients, as well as the factors favouring their development. It was reviewed clinical data and literature about secondary bacterial infections in particular, the frequency, the main responsible microorganisms and the mechanisms of development for this infection type. Measures that should be adopted for the control and management of secondary infections, including the antibiotic therapy used, were analysed and presented. COVID-19 is a complex disease, that in certain cases cause lung damage, exacerbated inflammation and subsequently development of immunosuppression, leading to a more complex medical care. All these factors combined make these patients more susceptible to acquire secondary infections. The average time to develop secondary infections after the hospital admission was estimated at 11.6 days, with infection rates ranging between 4.3 and 15%, and these cases are associated with worse prognosis, higher lethality and mortality. The infections were often bacterial, especially caused by Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, less frequent are fungal infections by Aspergillus spp. and Candida spp., and secondary virus infections were not expressive. Most patients were treated with antibiotic (67 – 100%), many on prophylaxis, contrary to recommended. Coronavirus pulmonary diseases will be a social and clinical challenge for many years, that is why it is important to understand the primary and secondary infections.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2021, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
SARS-CoV-2 COVID-19 Infeção secundária Infeção bacteriana Antibióticos Mestrado integrado - 2021