Factors assoociated with mortality in critically ill patients with COVID-19 overinfected due to carbapenem resistant organisms
Keywords:
Sobreinfección, BGNRC, COVID-19, mortalidad.Abstract
Introduction: Gram-negative bacilli are most frequently associated with bacterial superinfection in critically ill patients with COVID-19. Multidrug resistance in the ICU is emerging as a medical challenge.
Objective: To identify sociodemographic, epidemiological, clinical, microbiological, and therapeutic factors associated with mortality in patients superinfected with carbapenem-resistant Gram-negative bacilli (CRGNB) at El Tunal Hospital.
Methods: An observational, cross-sectional, analytical study was conducted on 150 critically ill patients infected with COVID-19 and superinfected with CRGNB between March 2020 and March 2022 in the ICU of the aforementioned hospital. Data were obtained from patient medical records and the Phoenix M50 automated system, which provided CRGNB isolates. Cox regression was used to identify factors associated with mortality, and Kaplan-Meier curves were used for survival analysis.
Results: The most frequently isolated microorganism was K. pneumoniae in 96 (64%) patients. 100 (66.6%) patients died. Survival after the onset of superinfection at 7, 14, and 21 days was 83.1%, 60.4%, and 48.7%, respectively. Predictive variables for mortality were renal replacement therapy (RRT) (OR = 3.3), age (OR = 3.0), microbiological isolation of K. pneumoniae (OR = 3.2), and requiring vasopressor support at the onset of superinfection (OR = 6.7).
Conclusions: K. pneumoniae was associated with most infections. The Cox regression model implied that; Requiring renal replacement therapy (RRT) and vasopressor support at the onset of the superinfection, advanced age, and K. pneumoniae infection were predictors of mortality.
Keywords: Superinfection, glomerular filtration rate (GFR), COVID-19, mortality.
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