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Abstract(s)
Introdução: A Pneumonia associada ao Ventilador (PAV) constitui a causa mais comum de infeção nosocomial na Unidade de Cuidados Intensivos (UCI), tendo sido reportada como uma complicação ainda mais prevalente em doentes com SARS-CoV-2. Esta maior incidência poderá estar dependente da própria lesão induzida pelo vírus, ou das condicionantes associadas à gestão pandémica.
Objetivos: Identificar a incidência de PAV em doentes COVID-19 com doença severa, identificar os agentes associados, assim como os fatores de risco para PAV.
Métodos: Foi realizado um estudo retrospetivo de doentes COVID-19 numa UCI durante a segunda vaga da pandemia em Portugal (2020-2021) em comparação com doentes com gripe internados na Unidade entre 2013 e 2020. Foi analisado o número de PAV, os agentes identificados, o número de dias sob ventilação mecânica invasiva (VMI), terapêuticas efetuadas, critérios de gravidade (SAPS II) e dados demográficos. Foi efetuada análise estatística descritiva e usada regressão logística para determinar fatores de risco.
Resultados: Foram incluídos 141 doentes críticos submetidos a VMI, dos quais 87 infetados por SARS-CoV-2 e 54 por influenza. A incidência de PAV foi superior no grupo de doentes COVID-19 (43.7% vs 29.6% em gripe). Através de análise multivariada, verificou-se que, entre vírus, não havia diferença estatisticamente significativa de predisposição para o desenvolvimento de PAV (OR: 0.75; p = 0.595). A ocorrência de PAV associou-se à corticoterapia (OR: 2.99; p = 0.010) e ao tempo de VMI (OR: 1.06; P < 0.001). A idade, o sexo masculino e o SAPS II não se associaram a maior risco de PAV. No grupo dos doentes COVID-19, 42.1% dos isolamentos foram por Klebsiella pneumoniae (42.1%), seguido por Serratia marcescens (13.1%) e MSSA (7.9%). No grupo de doentes com gripe, Pseudomonas aeruginosa representou 66.7% dos isolamentos.
Conclusões: No nosso centro, a infeção por SARS-CoV-2 não se associou a uma maior incidência de PAV quando ajustado para outras variáveis, ao invés da corticoterapia e do tempo de ventilação mecânica invasiva. Estes resultados sugerem que as alterações determinadas pelo vírus não serão o fator preponderante na ocorrência de VAP.
Background: Ventilator-associated Pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection and its was reported to be increased in COVID-19 patients. It is relevant to identify risk factors for this claim as well as the real impact of SARS-CoV-2 infection in comparison to other causes of lung injury. Objectives: To study the incidence of VAP in COVID-19 patients with severe disease and pathogens involved and to identify the main risk factors. Methods: We performed a retrospective study of COVID-19 patients in an ICU during the second wave of the pandemic in Portugal and compared it with a cohort of influenza patients admitted in the ICU between 2013 and 2020. Data regarding the number of VAP, pathogens involved, duration of IVM, corticosteroid treatment and demography were analyzed. We performed univariate and multivariate logistic regression to identify VAP risk factors. Results: This study included 141 critical patients undergoing IVM. 87 were infected with SARS-CoV-2 and 54 had influenza pneumonia. The incidence of VAP was higher in COVID-19 patients (43.7%), as compared to patients with influenza pneumonia (29.6%). However, when adjusted for severity, there was no statistically significant difference in predisposition to develop VAP among the two infections (OR: 0.75; p = 0.595). The factors associated with VAP occurrence, as shown by univariate and multivariate analysis, were corticotherapy (OR: 2.99; p = 0.010) and the duration of invasive mechanical ventilation (OR: 1.06; P < 0.001). Age, male gender, and SAPS II were not associated with increased risk of VAP. In COVID-19 patients, 42.1% of isolates were Klebsiella pneumoniae (42.1%), followed by Serratia marcescens (13.1%), MSSA (7.9%) and Streptococcus pneumoniae (7.9%). In influenza patients, Pseudomonas aeruginosa accounted for 66.7% of the isolations. Conclusion: There was no association of the type of primary infection (influenza or SARS-CoV-2) with the development of VAP, and the administration of corticosteroids and the duration of invasive mechanical ventilation were identified as the major risk factors associated with VAP.
Background: Ventilator-associated Pneumonia (VAP) is the most frequent intensive care unit (ICU)-acquired infection and its was reported to be increased in COVID-19 patients. It is relevant to identify risk factors for this claim as well as the real impact of SARS-CoV-2 infection in comparison to other causes of lung injury. Objectives: To study the incidence of VAP in COVID-19 patients with severe disease and pathogens involved and to identify the main risk factors. Methods: We performed a retrospective study of COVID-19 patients in an ICU during the second wave of the pandemic in Portugal and compared it with a cohort of influenza patients admitted in the ICU between 2013 and 2020. Data regarding the number of VAP, pathogens involved, duration of IVM, corticosteroid treatment and demography were analyzed. We performed univariate and multivariate logistic regression to identify VAP risk factors. Results: This study included 141 critical patients undergoing IVM. 87 were infected with SARS-CoV-2 and 54 had influenza pneumonia. The incidence of VAP was higher in COVID-19 patients (43.7%), as compared to patients with influenza pneumonia (29.6%). However, when adjusted for severity, there was no statistically significant difference in predisposition to develop VAP among the two infections (OR: 0.75; p = 0.595). The factors associated with VAP occurrence, as shown by univariate and multivariate analysis, were corticotherapy (OR: 2.99; p = 0.010) and the duration of invasive mechanical ventilation (OR: 1.06; P < 0.001). Age, male gender, and SAPS II were not associated with increased risk of VAP. In COVID-19 patients, 42.1% of isolates were Klebsiella pneumoniae (42.1%), followed by Serratia marcescens (13.1%), MSSA (7.9%) and Streptococcus pneumoniae (7.9%). In influenza patients, Pseudomonas aeruginosa accounted for 66.7% of the isolations. Conclusion: There was no association of the type of primary infection (influenza or SARS-CoV-2) with the development of VAP, and the administration of corticosteroids and the duration of invasive mechanical ventilation were identified as the major risk factors associated with VAP.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Keywords
COVID-19 SARS-CoV-2 Pneumonia associada ao ventilador Pneumonia nosocomial ARDS