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

Introducción: 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 C...

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Fecha de publicación:
2025
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Universidad del Rosario
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Repositorio EdocUR - U. Rosario
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spa
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Palabra clave:
Sobreinfección
Bacilos gram negativos resistentes a carbapenémicos
COVID-19
Mortalidad
Superinfection
Carbapenem-resistant gram-negative bacilli
COVID-19
Mortality
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Attribution-NonCommercial-NoDerivatives 4.0 International
id EDOCUR2_1cdf4ee6ec25034cd501d596275a8296
oai_identifier_str oai:repository.urosario.edu.co:10336/44960
network_acronym_str EDOCUR2
network_name_str Repositorio EdocUR - U. Rosario
repository_id_str
dc.title.none.fl_str_mv Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
dc.title.TranslatedTitle.none.fl_str_mv Factors associated with mortality in critically ill patients with COVID-19 and superinfection by Gram-negative microorganisms resistant to carbapenems
title Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
spellingShingle Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
Sobreinfección
Bacilos gram negativos resistentes a carbapenémicos
COVID-19
Mortalidad
Superinfection
Carbapenem-resistant gram-negative bacilli
COVID-19
Mortality
title_short Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
title_full Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
title_fullStr Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
title_full_unstemmed Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
title_sort Factores asociados a la mortalidad en pacientes críticos con COVID-19 y sobreinfección por microorganismos Gram negativos resistentes a carbapenémicos
dc.contributor.advisor.none.fl_str_mv Rodríguez Leguizamón, Giovanni
dc.subject.none.fl_str_mv Sobreinfección
Bacilos gram negativos resistentes a carbapenémicos
COVID-19
Mortalidad
topic Sobreinfección
Bacilos gram negativos resistentes a carbapenémicos
COVID-19
Mortalidad
Superinfection
Carbapenem-resistant gram-negative bacilli
COVID-19
Mortality
dc.subject.keyword.none.fl_str_mv Superinfection
Carbapenem-resistant gram-negative bacilli
COVID-19
Mortality
description Introducción: 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.
publishDate 2025
dc.date.accessioned.none.fl_str_mv 2025-02-10T19:14:08Z
dc.date.available.none.fl_str_mv 2025-02-10T19:14:08Z
dc.date.created.none.fl_str_mv 2025-02-07
dc.type.none.fl_str_mv bachelorThesis
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.spa.none.fl_str_mv Trabajo de grado
dc.identifier.uri.none.fl_str_mv https://repository.urosario.edu.co/handle/10336/44960
url https://repository.urosario.edu.co/handle/10336/44960
dc.language.iso.none.fl_str_mv spa
language spa
dc.rights.*.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.coar.fl_str_mv http://purl.org/coar/access_right/c_abf2
dc.rights.acceso.none.fl_str_mv Abierto (Texto Completo)
dc.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
Abierto (Texto Completo)
http://creativecommons.org/licenses/by-nc-nd/4.0/
http://purl.org/coar/access_right/c_abf2
dc.format.extent.none.fl_str_mv 57 pp
dc.format.mimetype.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Universidad del Rosario
Universidad CES. Facultad de Medicina
dc.publisher.department.none.fl_str_mv Escuela de Medicina y Ciencias de la Salud
dc.publisher.program.none.fl_str_mv Especialización en Epidemiología
publisher.none.fl_str_mv Universidad del Rosario
Universidad CES. Facultad de Medicina
institution Universidad del Rosario
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spelling Rodríguez Leguizamón, Giovanni4520256d-9d6b-4bf9-a6ef-06d67ab6fd84-1Carlos Olivers, Cobian CaballeroEspecialista en Epidemiología (en Convenio con el CES)Especialización44822b71-b527-4cd0-abcd-849ec55c78d1-12025-02-10T19:14:08Z2025-02-10T19:14:08Z2025-02-07Introducción: 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.Introduction: 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.57 ppapplication/pdfhttps://repository.urosario.edu.co/handle/10336/44960spaUniversidad del RosarioUniversidad CES. 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