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Special article
DOI: 10.1016/j.medine.2021.08.013
Available online 31 August 2021
Management of infectious complications associated with coronavirus infection in severe patients admitted to ICU
Manejo de las complicaciones infecciosas asociadas con la infección por coronavirus en pacientes graves ingresados en UCI
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Á. Estellaa,
Corresponding author
litoestella@hotmail.com

Corresponding author.
, P. Vidal-Cortésb, A. Rodríguezc, D. Andaluz Ojedad, I. Martín-Loechese, E. Díazf, B. Suberviolag, M.P. Gracia Arnillash, M. Catalán Gonzálezi, F. Álvarez-Lermaj, P. Ramírezk, X. Nuvialsl, M. Borgesm, R. Zaragozan
a Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Departamento de Medicina, Facultad de Medicina de Cádiz, Jerez de la Frontera, Cádiz, Spain
b Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
c Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain
d Servicio de Medicina Intensiva, Hospital Universitario de Sanchinarro de Madrid, Madrid, Spain
e PhD JFICMI Consultant in Intensive Care Medicine, CLOD Dublin Midlands Group, St James's University Hospital, Trinity Centre for Health Sciences, HRB-Welcome Trust St James's Hospital, Dublin, EIRE, Universidad de Barcelona, Barcelona, Spain
f Servicio de Medicina Intensiva, Hospital Parc Tauli, Sabadell, Spain
g Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
h Servicio de Medicina Intensiva, Hospital Universitario del Mar, Barcelona, Spain
i Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
j Servicio de Medicina Intensiva, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
k Servicio de Medicina Intensiva, Hospital La Fe de Valencia, Valencia, Spain
l Servicio de Medicina Intensiva, Hospital Vall d’Hebrón, Barcelona, Spain
m Unidad Multidisciplinar de Sepsis, Servicio de Medicina Intensiva, Hospital Universitario Son Llatzer, IDISBA, Enfermedades Infecciosas UIB, Palma de Mallorca, Área de Sepsis e Infecciosas, Federación Ibérica y Panamericana de Medicina Intensiva (FEPIMCTI), Palma de Mallorca, Spain
n Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
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Tables (6)
Table 1. Summary of studies on the effect of corticosteroids in SARS-CoV-2 pneumonia. Design, clinical outcomes and association to the development of infection.
Table 2. Summary of studies on the effect of tocilizumab in SARS-CoV-2 pneumonia. Design, clinical outcomes and association to the development of infection.
Table 3. Reported incidence of infectious complications in series of patients with severe SARS-CoV-2 pneumonia.
Table 4. Microbiological study of respiratory samples.
Table 5. Recommendations for the management of ventilator-associated respiratory infections in critical patients with SARS-CoV-2 pneumonia.
Table 6. Recommendations for the management of pulmonary aspergillosis in critical patients with SARS-CoV-2 pneumonia.
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Additional material (3)
Abstract

Infections have become one of the main complications of patients with severe SARS-CoV-2 pneumonia admitted in ICU. Poor immune status, frequent development of organic failure requiring invasive supportive treatments, and prolonged ICU length of stay in saturated structural areas of patients are risk factors for infection development. The Working Group on Infectious Diseases and Sepsis GTEIS of the Spanish Society of Intensive Medicine and Coronary Units SEMICYUC emphasizes the importance of infection prevention measures related to health care, the detection and early treatment of major infections in the patient with SARS-CoV-2 infections. Bacterial co-infection, respiratory infections related to mechanical ventilation, catheter-related bacteremia, device-associated urinary tract infection and opportunistic infections are review in the document.

Keywords:
SARS-CoV-2
Infection prevention
Pneumonia
Nosocomial
Opportunistic infections
Resumen

Las infecciones se han convertido en una de las principales complicaciones de los pacientes con neumonía grave por SARS-CoV-2 que ingresan en UCI. El deficiente estado inmunitario, el desarrollo frecuente de fracaso orgánico con necesidad de tratamientos de soporte invasivos y las estancias prolongadas en áreas estructurales en gran medida saturadas de enfermos son factores de riesgo para el desarrollo de infecciones. El Grupo de Trabajo de Enfermedades Infecciosas y Sepsis GTEIS de la Sociedad Española de Medicina Intensiva y Unidades Coronarias SEMICYUC enfatiza la importancia de las medidas de prevención de infecciones relacionadas con los cuidados sanitarios, y de la detección y tratamiento precoz de las principales infecciones en el paciente con infección por SARS-CoV-2. La coinfección bacteriana, las infecciones respiratorias relacionadas con la ventilación mecánica, bacteriemia relacionada con el catéter, infección del tracto urinario asociado a dispositivo e infecciones oportunistas son desarrolladas.

Palabras clave:
SARS-CoV-2
Prevención infecciones
Neumonía
Nosocomial
Infecciones oportunistas

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