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Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos

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dc.contributor.advisorRodríguez Leguizamón, Giovanni
dc.creatorCarlos Olivers, Cobian Caballero
dc.creator.degreeEspecialista en Epidemiología (en Convenio con el CES)
dc.creator.degreeLevelEspecialización
dc.date.accessioned2025-02-10T19:14:08Z
dc.date.available2025-02-10T19:14:08Z
dc.date.created2025-02-07
dc.descriptionIntroducción: Los bacilos gram negativos constituyen las principales bacterias relacionadas con la sobreinfección bacteriana en pacientes críticos con COVID-19. Mostrando un amplio espectro de resistencia a los antimicrobianos. Las bacterias multidrogo-resistentes, especialmente en las Unidades de Cuidado Intensivo, emergen como un desafío para la comunidad médica mundial. Objetivo: Identificar los factores sociodemográficos, epidemiológicos, clínicos, microbiológicos y terapéuticos asociados a la mortalidad, en la población de pacientes con infección por COVID-19, con sobreinfección por bacilos gram negativos resistentes a carbapenémicos (BGNRC), en un hospital de referencia en la ciudad de Bogotá. Métodos: Estudio observacional, de corte transversal analítico, en 150 pacientes críticos con infección por COVID-19, con sobreinfección por BGNRC, en el período comprendido entre marzo de 2020 y marzo de 2022. El estudio se desarrolló en la Unidad de Cuidados Intensivos del hospital El Tunal. Los datos se obtuvieron de los registros clínicos de los pacientes y del sistema automatizado Phoenix M50 (panel 406) que proporcionó los aislamientos de BGNRC. Se realizó regresión logística multivariada mediante un modelo de riesgos proporcionales o regresión de Cox para identificar la carga de factores asociados a la mortalidad. Para el análisis de supervivencia, se emplearon las curvas de Kaplan-Meier. Resultados: La media del diagnóstico de sobreinfección bacteriana para microorganismos con resistencia a carbapenémicos luego del ingreso a UCI fue de 11 días (DE 7,7). El microorganismo aislado con más frecuencia fue K. Pneumoniae en 96 (64%) pacientes. Meropenem más ertapenem en 49 (32,6%) pacientes fue el esquema antibiótico dirigido que más se empleó. Fallecieron 100 (66,6%) pacientes. La probabilidad de supervivencia a los 7, 14 y 21 días, fue de 99,3%; 92,0% y 73,3% respectivamente. La supervivencia luego del inicio de la sobreinfección a los 7, 14 y 21 días fue de 83,1%; 60,4% y 48,7% respectivamente. Las variables predictivas de mortalidad resultaron ser la TRR (OR= 3,3; IC 95%: 1,2-8,8), la edad (OR= 3,0; IC 95%: 1,1-7,6), el aislamiento microbiológico de K. pneumoniae (OR= 3,2; IC 95%: 1,3-7,8) y el requerimiento de soporte vasopresor al inicio de sobreinfección (OR= 6,7; IC 95%: 2,7-16,8). Conclusiones: La K. pneumoniae constituyó el microorganismo responsable de la mayoría de las infecciones. La terapia con meropenem y ertapenem fue el esquema antibiótico más utilizado. El modelo de regresión de Cox arrojó que el requerir TRR, la edad, tener una infección por K. pneumoniae y requerir soporte vasopresor al inicio de la sobreinfección fueron las variables predictoras de mortalidad.
dc.description.abstractIntroduction: Gram-negative bacilli constitute the main bacteria related to bacterial superinfection in critically ill patients with COVID-19. Showing a wide spectrum of resistance to antimicrobials. Multidrug-resistant bacteria, especially in Intensive Care Units, emerge as a challenge for the global medical community. Objective: To identify the sociodemographic, epidemiological, clinical, microbiological and therapeutic factors associated with mortality, in the population of patients with COVID-19 infection, with superinfection by carbapenem-resistant gram-negative bacilli (CRGB), in a reference hospital in the city of Bogotá. Methods: Observational, analytical cross-sectional study, in 150 critically ill patients with COVID-19 infection, with BGNRC superinfection, in the period between March 2020 and March 2022. The study was carried out in the Intensive Care Unit of the El Tunal hospital. Data were obtained from the patients' clinical records and from the Phoenix M50 automated system (panel 406) that provided the BGNRC isolates. Multivariate logistic regression was performed using a proportional hazards model or Cox regression to identify the burden of factors associated with mortality. For survival analysis, Kaplan-Meier curves were used. Results: The mean diagnosis of bacterial superinfection for microorganisms with resistance to carbapenems after admission to the ICU was 11 days (SD 7.7). The most frequently isolated microorganism was K. Pneumoniae in 96 (64%) patients. Meropenem plus ertapenem was the most frequently used targeted antibiotic regimen in 49 (32.6%) patients. 100 (66.6%) patients died. The probability of survival at 7, 14 and 21 days was 99.3%; 92.0% and 73.3% respectively. Survival after the onset of superinfection at 7, 14 and 21 days was 83.1%; 60.4% and 48.7% respectively. The predictive variables of mortality turned out to be RRT (OR= 3.3; 95% CI: 1.2-8.8), age (OR= 3.0; 95% CI: 1.1-7.6), microbiological isolation of K. pneumoniae (OR= 3.2; 95% CI: 1.3-7.8) and the requirement for vasopressor support at the beginning of superinfection (OR= 6.7; CI 95%: 2.7-16.8). Conclusions: K. pneumoniae was the microorganism responsible for the majority of infections. Therapy with meropenem and ertapenem was the most used antibiotic regimen. The Cox regression model showed that requiring RRT, age, having a K. pneumoniae infection, and requiring vasopressor support at the beginning of the superinfection were the predictor variables of mortality.
dc.format.extent57 pp
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_44960
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/44960
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisherUniversidad CES. Facultad de Medicina
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programEspecialización en Epidemiología
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectSobreinfección
dc.subjectBacilos gram negativos resistentes a carbapenémicos
dc.subjectCOVID-19
dc.subjectMortalidad
dc.subject.keywordSuperinfection
dc.subject.keywordCarbapenem-resistant gram-negative bacilli
dc.subject.keywordCOVID-19
dc.subject.keywordMortality
dc.titleFactores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
dc.title.TranslatedTitleFactors associated with mortality in critically ill patients with COVID-19 and superinfection by Gram-negative microorganisms resistant to carbapenems
dc.typebachelorThesis
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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Especialización en Epidemiología