medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2026.4.110medjournal-481Research ArticleОРИГИНАЛЬНЫЕ НАУЧНЫЕ ПУБЛИКАЦИИORIGINAL SCIENTIFIC PUBLICATIONSБактериемия у госпитализированных пациентов с COVID-19: частота развития и факторы рискаBACTEREMIA IN HOSPITALIZED PATIENT WITH COVID-19: INCIDENCE AND RISK FACTORSСильвановичЕ. А.SilvanovichK. A.

Минск

Minsk

ЛитвинчукД. В.LitvinchukD. V.

Минск

Minsk

УО «Белорусский государственный медицинский университет»БеларусьBelarusian State Medical UniversityBelarus20262710202604110115Copyright © Сильванович Е.А., Литвинчук Д.В., 20262026Сильванович Е.А., Литвинчук Д.В.Silvanovich K.A., Litvinchuk D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/481Цель исследования

Цель исследования: оценить частоту развития и факторы риска бактериемии у госпитализированных пациентов с COVID-19 в различные периоды пандемии.

Методы

Методы. В исследование включены 11203 пациента, госпитализированных с диагнозом COVID-19 в УЗ «Городская клиническая инфекционная больница» г. Минска в период с марта 2020 по июнь 2023 гг. Оценка частоты встречаемости бактериемии и факторов риска, ассоциированных с ее развитием в условиях конкурирующих рисков, выполнялась с использованием моделей причинно-специфической регрессии Кокса. Статистический анализ выполнялся в R 4.3.4.

Результаты

Результаты. В исследование включены 11 203 пациента, в том числе у 1496 пациентов выполнено 2971 исследование крови на стерильность. Кумулятивная инцидентность бактериемии в период пандемии COVID-19 до вариантов Омикрон составила 0,86 % и 1,63 % в период преобладания вариантов SARS-CoV-2 Омикрон. В этиологической структуре преобладали K. pneumoniae (31,7 %), S. aureus (15,3 %), E. coli (15,3 %), A. baumanii (14,2 %). Независимыми факторами риска бактериемии с учетом конкурирующих рисков (выписка из стационара, летальный исход) в период преобладания ранних вариантов SARS-CoV-2 (до Омикрон) являлись: дыхательная недостаточность – ОР 3,69 [95 % ДИ 2,18–6,25], p < 0,01, ожирение – ОР 3,04 [95 % ДИ 1,83-5,06], p < 0,01, возраст – ОР 1,04 [95 % ДИ 1,02–1,07], p < 0,01, мужской пол – ОР 1,94 [95 % ДИ 1,17–3,20], p < 0,01. В период преобладания вариантов Омикрон развитие бактериемии было ассоциировано с наличием болезней печени – ОР 4,26 [95 % ДИ 2,37–7,67], p < 0,01, дыхательной недостаточности – ОР 3,72 [95 % ДИ 2,14–6,44], p < 0,01 и хронической обструктивной болезни легких – ОР 5,11 [95 % ДИ 1,50–17,40], p < 0,01. Антибактериальная терапия на догоспитальном этапе не была ассоциирована со снижением частоты бактериемии – ОР 0,86 [95 % ДИ 0,51–1,46], p = 0,58 до Омикрон; ОР 1,07 [95 % ДИ 0,52–2,18], p = 0,86 в период Омикрон).

Заключение

Заключение. Период SARS-CoV-2 Омикрон характеризовался большей частотой бактериемии у госпитализированных пациентов. Факторами риска бактериемии в период до Омикрон являлись дыхательная недостаточность, ожирение, мужской пол и возраст, в период Омикрон – болезни печени, дыхательная недостаточность, хроническая обструктивная болезнь легких. Антибактериальная терапия на амбулаторном этапе не была ассоциирована со снижением риска бактериемии.

Aim

Aim. The aim of the study is to assess the incidence and risk factors of bacteremia in hospitalized patients with COVID-19 during different periods of the pandemic.

Methods

Methods. The study included 11203 patients diagnosed with COVID-19 who were hospitalize in Minsk City Clinical Infectious diseases Hospital, from 1 June 2021 to 30 June 2023. The incidence of bacteremia and risk factors associated with its development in conditions of competing risks were assessed using Cox cause-specific regression models. Statistical analysis was performed in R 4.3.4. Results. The study included 11203 patients, of whom 1496 patients had 2971 blood culture tests. The cumulative incidence of bacteremia was 0.86 % during the COVID-19 pandemic before the Omicron variants and 1.63 % during the period of prevalence of SARS-CoV-2 Omicron variants. The predominant etiology was K. pneumoniae (31,7 %), S. aureus (15,3 %), E. coli (15,3 %), A. baumanii (14,2 %). Respiratory failure – HR 3.69 [95 % CI 2.18–6.25], p < 0.01, obesity – HR 3.04 [95 % CI 1.83-5.06], p < 0.01, age – HR 1.04 [95 % CI 1.02–1.07], p < 0.01, male gender – HR 1.94 [95 % CI 1.17–3.20], p < 0.01 were associated with bacteremia incidence in pre-Omicron SARS-CoV-2. During Omicron variants, bacteremia incidence was associated with the presence of liver disease – HR 4.26 [95 % CI 2.37–7.67], p < 0.01, respiratory failure – HR 3.72 [95 % CI 2.14–6.44], p < 0.01, COPD – HR 5.11 [95 % CI 1.50–17.40], p < 0.01. Antibacterial therapy before admission was not associated with incidence of bacteremia – HR 0.86 [95 % CI 0.51–1.16], p = 0.58 pre-Omicron; HR 1.07 [95 % CI 0.52-2.18], p = 0.86 during Omicron).

Conclusion

Conclusion. Incidence of bacteremia increased almost two-fold during SARS-CoV-2 Omicron predominance. Risk factors for bacteremia in the pre-Omicron period included respiratory failure, obesity, male gender, and age, while in the Omicron period, risk factors were liver disease, respiratory failure, and chronic obstructive pulmonary disease. Antibacterial treatment before admission was not associated with in-hospital bacteremia incidence.

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The authors declare that there are no conflicts of interest present.