| Part Ⅰ:Analysis of clinical characteristics of severe COVID-19 patients with Acinetobacter baumannii infectionObjective:To analyze the clinical characteristics and prognostic risk factors of Acinetobacter baumannii infection in severe COVID-19 patients in the First Affiliated Hospital of Jiangsu University,so as to provide basis for individualized treatment of severe COVID-19 patients.Methods:The clinical data of severe COVID-19 patients admitted to the Department of Infectious Diseases,Critical Care Medicine,and Respiratory and Critical Care Medicine of the First Affiliated Hospital of Soochow University from November 1,2022 to January 31,2023 were retrospectively analyzed,including Patients’ gender,age,underlying diseases,clinical symptoms,comorbidities,duration of mechanical ventilation,whether deep vein catheterization,length of hospital stay,whether hormones were used,and acute physiology and chronic health evaluation Ⅱ(APACHE physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)Scoring and laboratory examination indicators,including white blood cell count,lymphocyte count,neutrophil count,NLR,hemoglobin,platelet count,C-reactive protein(C-reactive protein,CRP),prothrombin time,D-dimer,interleukin-6(IL-6),interleukin-8(IL-8),total bilirubin,alanine aminotransferase,aspartate aminotransferase,albumin,serum creatinine,lactate dehydrogenase(LDH),muscle Acid kinase,Procalcitonin(PCT),BNP.According to the infection of Acinetobacter baumannii,the patients were divided into infection group and non-infection group.According to the prognosis of patients 28 days after admission,they were divided into improvement group and death group.The clinical characteristics and prognostic risk factors of severe COVID-19 patients complicated with Acinetobacter baumannii infection were analyzed by mean±standard deviation,t test,chi-square test,univariate and multivariate Logistic regression models.Results:1.In this study.82 patients were finally selected.Of the selected severe COVID-19 patients,34 cases had pulmonary Acinetobacter baumannii infection,the incidence rate was 41.46%.and 48 cases had no pulmonary Acinetobacter baumannii infection.The incidence rate was 58.54%.2.There were 34 severe COVID-19 patients with Acinetobacter baumannii infection,including 29 males and 5 females,with an average age of 73.18 years.Among the 82 patients with severe COVID-19.the most common underlying diseases were hypertension in 57 cases(69.5%).diabetes in 28 cases(34.1%).coronary heart disease in 13 cases(15.8%).lung disease in 8 cases(9.7%).There were 8 cases(9.7%)of cerebrovascular diseases and 6 cases(7.3%)of tumors.The clinical symptoms were cough,fever,chest tightness,and expectoration,among which 61 cases(74.4%)had cough,51 cases(62.2%)had fever 46 cases(56.1%)had chest tightness.39 cases(47.6%)had expectoration,and 29 cases had asthma(35.4%).fatigue in 15 cases(18.3%).Complications often included shock in 32 cases(39.0%).hypoalbuminemia in 28 cases(34.1%).renal insufficiency in 26 cases(31.7%).and respiratory failure in 23 cases(28.0%).3.The results showed that the hospitalization time ≥ 14 days,hospitalization time≥ 28 days,mechanical ventilation time≥5 days,use of ≥3 types of antibiotics,and continuous antibiotic use time>7 days were statistically different between the Bowman-infected group and the non-infected Bowman group(P<0.05).It shows that in patients with Acinetobacter baumannii infection,the hospitalization time,mechanical ventilation time,type of antibiotics used and the time of antibiotic continuous use are all higher than those after non-Acinetobacter baumannii infection,which proves that these factors are related to Acinetobacter baumannii infection related to the occurrence.4.Among the laboratory indicators,the amount of hemoglobin(t=-2.609.P=0.011<0.05)and IL-6(U=436.5,P=0.001<0.05)were significantly different between the infected Bowman group and the non-infected Bowman group Statistically significant,the amount of hemoglobin in the Bownan-infected group was lower than that in the control group,and the IL-6 in the Bowman-infected group was much higher than that in the control group.It can be considered that the amount of hemoglobin and IL-6 in the Bowman-infected group and the non-infected Bowman group were significantly different.5.The results of binary Logistic regression analysis showed that the duration of mechanical ventilation≥ 5 days(OR=36.000,95%CI:9.038-143.390,P<0.001)was an independent risk factor affecting Acinetobacter baumannii infection,that is,the duration of mechanical ventilation≥ The risk of Acinetobacter baumannii infection for 5 days was 36.000 times that of mechanical ventilation for less than 5 days.6.Univariate analysis showed that whether combined with shock,elevated IL-6,elevated IL-8,elevated aspartate aminotransferase,elevated lactate dehydrogenase,and elevated NLR were risk factors associated with patient death(P<0.05).Logistic regression analysis was carried out by stepwise regression method.The results showed that shock(OR=0.111,95%CI:0.022-0.560,P=0.008),lymphocytes(OR=571.304,95%CI:1.369-238450.480,P=0.039)and lactate dehydrogenase(OR=0.991,95%CI:0.983-0.0.999,P=0.025)were independent risk factors affecting the death of Acinetobacter baumannii infection.Conclusion:1.High-risk factors for Acinetobacter baumannii infection in severe COVID-19 patients include elevated interleukin-6,length of hospital stay ≥ 14 days,duration of mechanical ventilation≥ 5 days,types of antibiotics used≥ 3 kinds,and duration of continuous use of antibiotics≥ 7 days.Once combined with Acinetobacter baumannii infection,it is easy to cause prolonged mechanical ventilation time,prolonged hospital stay,and increased mortality.The duration of mechanical ventilation was an independent risk factor for the infection of Acinetobacter baumannii.2.Factors affecting the prognosis of patients with severe COVID-19 complicated with Acinetobacter baumannii infection include shock,elevated IL-6,elevated IL-8,elevated aspartate aminotransferase,elevated lactate dehydrogenase,and elevated NLR High,among which the combination of shock,decreased lymphocytes and elevated lactate dehydrogenase are independent risk factors for prognosis.Part II:The clinical application value of M-ROSE and its influence on the prognosis of critically ill patientsObjective:To explore the clinical application value of microbiological rapid on-site evaluation(M-ROSE sputum smear technology)in the rapid and accurate diagnosis and treatment of severe COVID-19 Ab patients and the evaluation and judgment of curative effect,so as to provide a basis for this technology to guide the rapid and accurate clinical use of antibacterial therapy.M ethods:(1)Patients who were diagnosed with severe COVID-19 complicated with Bowman infection and agreed to undergo bedside M-ROSE in the First Affiliated Hospital of Soochow University from January 11,2022 to January 31.2023 were retrospectively included.Each clinical sputum sample since admission was divided into two equal parts for ROSE and bacterial culture respectively.In the end,the mass spectrometry results of the clinical laboratory were used as the gold standard to compare the consistency between the results of the M-ROSE sputum smear and the results reported by the laboratory.Then select the clinical sputum samples diagnosed with Baumann’s infection,and compare the time between M-ROSE and sputum culture to confirm Baumann’s infection.(2)A total of 34 patients who were diagnosed with severe COVID-19 combined with Baumann infection between January 11.2022 and January 31,2023 in the First Affiliated Hospital of Soochow University were selected for inclusion in the study.According to whether bedside M-ROSE was used to guide treatment,patients were divided into M-ROSE group(13 cases)and control group(21 cases).In the M-ROSE group,the diagnostic method based on M-ROSE sputum smear was used to guide the treatment regimen and time of medication.The control group adopted the diagnostic criteria recommended by the diagnosis and treatment guidelines to formulate treatment plans and medication time schedules and received conventional treatment.Collect and analyze basic information such as patient demographic characteristics,laboratory indicators,treatment methods,and prognosis assessment(including the use of antibiotics,length of hospital stay,clinical outcomes,etc.).Results:1.Among the 254 reports of sputum culture results,there were 75 cases with definite Acinetobacter baumannii infection and 179 cases with non-definite Baumannii infection.The detection rate was 29.5%(75/254).Among the 254 M-ROSE evaluation results,there were 77 cases with definite Acinetobacter baumannii infection and 177 cases with non-definite Baumannii infection.The detection rate was 30.3%(77/254).2.Taking the test results as the gold standard,the sensitivity of M-ROSE for the diagnosis of pulmonary Acinetobacter baumannii infection was 100%(75/75),and the specificity was 98.9%(177/179).The diagnostic results of M-ROSE for pulmonary infection were highly consistent with those of laboratory etiology.The accuracy of M-ROSE in patients was 100%consistent with the results of bacterial culture,indicating that M-ROSE has a higher diagnostic accuracy for Bowman.3.The average time for patients to complete the diagnosis of ROSE was(22.67±5.458)minutes,and the average time to complete the diagnosis of sputum bacterial culture was(5568±1883.987)minutes.The reporting time of M-ROSE results was(3.61 ± 1.28)days faster than that of bacterial culture results,and the differences were statistically significant(P<0.05).4.There was no significant difference in clinical outcomes between the two groups(P>0.05).Conclusion:Bedside rapid sputum smear Gram staining microscopic examination has certain value in early identification of severe COVID-19 patients with Acinetobacter baumannii infection.Our study demonstrated for the first time that M-ROSE is helpful in the diagnosis of severe COVID-19 patients with Acinetobacter baumannii infection.M-ROSE is helpful for early and rapid diagnosis of pathogenic microorganisms,and can provide early treatment basis for future clinical treatment,with a view to guiding antibiotic regimens for critically ill patients,improving disease progression,reducing mortality,and improving patient prognosis. |
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