ABSTRACT
In patients with SARS-CoV-2 pneumonia, the increase in secondary infection by nosocomial microorganisms has alerted the health system. This is due to the increase in hospital stay and the final fatal outcome in critically ill patients. The following series of cases was carried out to evaluate the isolation of Stenotrophomonas maltophilia in hospitalized patients with COVID-19 in bronchial secretion samples. Seven patients were found associated with an excessive prescription of antibiotics with low susceptibility to Stenotrophomonas maltophilia and the presence of secondary bacterial infection by this microorganism associated with the use of invasive mechanical ventilation. This creates a dilemma in the medical strategies and recommendations used in many institutions for patients with SARS-CoV-2 pneumonia in need of an intensive care unit. © 2021
ABSTRACT
Objective: To determine the factors related to bacterial pneumonia in patients with COVID-19 in an intensive care unit in Barranquilla, Colombia. Design: Nested, single-center case-control study, conducted between March and August 2020. Patients: Patients over 18 years of age, a hospital stay greater than 72 h, with invasive mechanical ventilation support admitted to the intensive care unit. Interventions: None. Measurements: Clinical variables were grouped for both cases and controls. Means and standard deviation were calculated in quantitative variables and proportions in categorical variables. Fisher's exact test was used to evaluate the differences between proportions, and the Mann-Whitney U test was used for differences in means. Variables with statistically significant differences were run in an explanatory model based on binary logistic regression. Results: The frequency of bacterial pneumonia was 10.07%, finding a high consumption of empirical antibiotic therapy. A statistical association was found between the time of dexamethasone use (OR 1.520;95% CI 1.131-2.042) with the development of bacterial pneumonia. The rest of the variables were not statistically significant after adjusting the model with logistic regression. Conclusion: Low rates of bacterial pneumonia were found, with Klebsiella pneumoniae prevailing as the most frequent bacterium. Overuse of dexamethasone in intensive care unit COVID-19 patients could increase the risk of bacterial pneumonia. For this reason, it must be evaluated in greater depth to explain causality and effect. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
ABSTRACT
As the current SARS-CoV-2 virus pandemic progresses, scientific evidence of complications in the evolution of the disease is increasing. Pneumothorax is a common complication of acute respiratory distress syndrome, which significantly increases the mortality of patients. However, in COVID-19 to date there are few articles that report this complication. Below are two cases of patients with pneumonia complicated by COVID-19 with primary spontaneous pneumothorax without prior hospitalization. The first patient, a 63-year-old woman with hypertension, hypothyroidism and tobacco addiction, developed pneumonia complicated by COVID-19 with pneumothorax, recovered progressively and was discharged 20 days after admission to the unit. The second patient, a 44-year-old man with obesity, developed pneumonia complicated by COVID-19 with pneumothorax, which during his stay progressed to septic shock and he died. Timely identification of possible complications due to COVID-19 is crucial for reducing mortality, and therefore they should be suspected in all types of patients with SARS-CoV-2 pneumonia on their first admission to health centres. © 2021