Selon un article paru dans la revue « The Lancet », 15% des personnes infectées admises en réanimation ont une infection bactérienne à la suite de l’infection au Coronavirus.
C’est la cause de la moitié des décès. Cependant, le problème qui peut être plus grave, c’est l’émergence et la multiplication de souches pathogènes multirésistantes aux antibiotiques.
Concernant les infections bactériennes secondaires « des surinfections bactériennes, soit à l’entrée, soit en cours d’hospitalisation (pneumopathie acquise sous ventilation mécanique ou PAVM) sont fréquentes », explique Benoit Grandjean, anesthésiste réanimateur à Epinal.
Timothée Abaziou, anesthésiste réanimateur à Toulouse, ajoute « qu’après l’infection initiale, il est possible qu’il y ait une phase d’immunodépression comme en témoignerait la lymphopénie (taux de lymphocytes anormalement bas) fréquemment observée, rendant les patients plus susceptibles aux infections, notamment fongiques. De plus, ces patients font déjà partie des patients à risque d’infections associées aux soins, de par la durée de ventilation, de sédation et les dispositifs invasifs généralement utilisés (voie veineuse centrale, cathéter artériel, sonde urinaire à demeure…). »
Sur la question de l’utilisation des antibiotiques, ces deux médecins ne constatent pas la même chose dans leurs services respectifs.
« L’utilisation des antibiotiques a fortement augmenté, car il y a trois fois plus de patients, qui sont tous graves (presque 100 % de ventilation invasive chez nos patients en réanimation).
De plus, ils sont ventilés longtemps et on sait que le risque de PAVM augmente avec le temps. L’utilisation d’antibiotiques est donc nécéssaire », nous informe Benoît Grandjean.
Quant à Timothée Abaziou, il nous explique que « l’utilisation d’antibiotiques ne semble pas avoir augmenté dans mon unité. Cependant, je travaille dans une réanimation dans laquelle beaucoup de patients viennent pour des chocs septiques de diverses causes, et que l’utilisation d’antibiotiques y est par conséquent très courante, ce qui peut constituer un biais. »
Aux Etats-Unis, par contre, les médecins s’inquiètent vraiment de la consommation excessive et sans prescriptions d’antibiotiques. Ils attendent des recommandations émanant des autorités sanitaires afin de gérer au mieux cette crise et d’éviter qu’une vague d’antibiorésistance submerge les hôpitaux.
Source : FUTURA SCIENCES
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