Infecções primárias de corrente sanguínea: impacto da COVID-19 no perfil microbiano e desfecho fatal dos pacientes internados em ambiente hospitalar

Abstract

Healthcare-Associated Infections (HAIs) are characterized as an infectious condition resulting from healthcare procedures, which can manifest during hospitalization or after discharge. Approximately 60% of HAIs are related to invasive devices, including Primary Bloodstream Infections (IPCS), associated with central venous catheters (CVC). During the COVID-19 pandemic, there was an increase in the number of IPCS and the spread of multi-resistant microorganisms. The objective of this study was to analyze the impact of COVID-19 on IPCS, in terms of outcome, microbiological profile, association with the use of CVC, time between hospitalization and diagnosis of IPCS and changes in hematological parameters and review the literature regarding the change or not the microbiological profile of IPCS. To this end, data from 299 patients with IPCS between 2019 and 2022, who were admitted to a University Hospital in the Southern region of Brazil, were analyzed. Patients were separated into two groups: those who were associated with COVID-19 (suspected and confirmed) and those who were not associated with COVID-19. Regarding the profile of patients who presented IPCS, the average age was 61.8 years (SD 19.0), male (60.8%), Caucasian (91.3%) and with low education (62.2%). %). In both groups, the majority of infections were caused by Gram-positive bacteria, mainly Sthapylococcus spp (26.1% of all cases). Among Gram-negative bacteria, infections caused by Klebisella pneumoniae were the most

prevalent in suspected or confirmed COVID-19 patients, while in non-COVID-19 patients, lactose- ferminating enterobacteria (except K. pneumoniae) were more common. Multidrug-resistant bacteria

were more common in the COVID-19 group (23.6%), differing significantly from the non-COVID-19 group. Among IPCS in suspected or confirmed COVID-19 patients, 84% were associated with CVC,

which differed statistically from the non-COVID-19 group (Chi-square p<0.001). Patients with catheter- associated IPCS had a longer median (13.5 days) time between hospital admission and IPCS diagnosis.

Higher rates of fatal outcome were observed in the COVID-19 group (50.7%) compared to the non- COVID-19 group (33.3%), with 38.7% of deaths being associated with the Stapylococcus genus. Simple

logistic regression showed that suspicion or confirmation of COVID-19 significantly impacted the probability of death in patients with IPCS (X2 = 9.24, p=0.002; R2cs = 0.0412). The calculated Odss Ratio allows us to state that those with IPCS were twice as likely to die when they had COVID-19 (suspected or confirmed). It is concluded that COVID-19 infections contributed to the increase in the prevalence of IPCS, with patients suspected or confirmed for COVID-19 having a greater chance of death and the majority of cases being associated with CVC, and based on the findings of the literature review we inferred that there was no significant difference in the microbial profile and what changed was the presence of multi-resistant microorganisms.