Fatores associados à colonização por Klebsiella pneumoniae carbapenemase em pacientes críticos com Covid-19

Abstract

Objective: To analyze factors associated with Klebsiella Pneumoniae Carbapenemase (KPC) colonization in patients with COVID-19 in an adult Intensive Care Unit. Method: Case-control, retrospective study, carried out in an adult ICU of a teaching hospital, intended for the treatment of patients with COVID-19, from November/2020 to December/2021. During hospitalization, a group of 27 patients was identified as having the bacteria Klebsiella Pneumoniae Carbapenemase. This group was called the "case group". On the other hand, a "control group" was formed by 336 patients who did not present colonization with bacteria resistant to multiple drugs. In addition, a third group was created, called the "others group", composed of 50 patients who had colonization by other bacteria resistant to multiple drugs. Patients included in all groups were positive for SARS-COV-2. Kolmogorov-Smirnov and Pearson chisquare tests were used for statistical analyses. In situations where significant differences were verified, "Poshoc chi-square" was performed. This study was submitted to the Research Ethics Committee through the Brazil platform, with favorable opinion nº 3,087,908 - according to resolution 466/2012. Results: Most patients were male (51.4%), aged 20-59 years (54.1%) and 50.8% died. The incidence of KPC was 7.45% and the average colonization time was 9.9 days. There was a statistically significant difference in the groups of patients colonized by KPC and those colonized by other microorganisms when comparing the patient's origin, being greater in other municipalities than in the capital and metropolitan region. KPC colonization was associated with a length of hospital stay of more than seven days, use of antimicrobials for more than seven days, and orotracheal intubation. There was no association between KPC colonization and mortality, previous hospitalization unit, morbidity and device use at admission. Conclusion: Factors associated with KPC colonization were length of stay, previous use of antimicrobials and orotracheal intubation. Knowing these factors is important for directing infection prevention and control actions