Fatores associados à aquisição de Covid-19 intra-hospitalar

Abstract

Healthcare-Related Infections are a serious global health problem, as they increase morbidity and mortality and prolong patients' hospital stays. With the emergence of a new coronavirus in December 2019, a new international emergency infection has arisen. In view of this, this study aims to assess the risk factors associated with in-hospital transmission of Covid19 in an intensive care unit. A 3:1 case-control study was carried out, with a total of 44 case patients and 132 control patients. In both groups, 59.1% of the patients were male and 71.9% of the control group had radiographic alterations. With regard to comorbidities, 84% of the cases and 89.3% of the controls had some condition. Co-infections, identified by cultures, were positive in 84% and 56% of the groups respectively. The average number of days using central venous access, delayed bladder catheterization and mechanical ventilation was higher in patients with hospital-acquired Covid. The number of days using antimicrobials was higher in the case group (63) compared to the control group (59), as was the length of ICU stay, 118 and 70 respectively. The total length of stay was longer in the control group (258) than in the case group (130). The death rate was higher than the discharge rate in both groups, representing 65.9% of cases and 52.2% of controls. The microbiological profile of the coinfections was predominantly Gram-negative bacteria (64%), with the most frequently isolated microorganisms being Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. This was followed by Gram-positive bacteria (18.8%) and fungi (17.2%). In the multivariate analysis, patients who had some type of cancer (p=0.010), those with hypertension as a comorbidity (p=0.086) or cardiovascular disease (p=0.022) who returned to the ICU (p=0.0006) and those with a positive tracheal secretion culture (p=0.0121) were more likely to acquire hospital-acquired Covid. A general rate of resistance to antimicrobials was observed, highlighting Acinetobacter baumannii, which among the five main bacterial species classified as multidrug-resistant had high rates in both groups (84.6% and 90.4%). Through the research, it can be concluded that some conditions such as comorbidities and the use of medical devices are relevant factors and predictors for patients acquiring Covid in-hospital, as well as imaging tests showing relevance for the outcome of patients after hospitalization.