Little is known about the epidemiology of ventilator-acquired pneumonia among coronavirus disease 2019 patients such as incidence or etiological agents. Some studies suggest a higher risk of ventilator-associated pneumonia in this specific population.

Rationale Patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are at higher risk of ventilator-associated pneumonia (VAP) and may have an increased attributable mortality (increased or decreased risk of death if VAP occurs in a patient) and attributable fraction (proportion of deaths that are attributable to an exposure) of VAP-related mortality compared with subjects without coronavirus disease (COVID-19). Objectives Estimation of the attributable mortality of the VAP among patients with COVID-19. Methods Using the REA-REZO surveillance network, three groups of adult medical ICU patients were computed: control group (patients admitted between 2016 and 2019; prepandemic patients), pandemic COVID-19 group (PandeCOV + ), and pandemic non–COVID-19 group (PandeCOV − ) admitted during 2020. The primary outcome was the estimation of attributable mortality and attributable fraction related to VAP in these patients. Using multistate modeling with causal inference, the outcomes related to VAP were also evaluated. Measurements and Main Results A total of 64,816 patients were included in the control group, 7,442 in the PandeCOV − group, and 1,687 in the PandeCOV + group. The incidence of VAP was 14.2 (95% confidence interval [CI], 13.9 to 14.6), 18.3 (95% CI, 17.3 to 19.4), and 31.9 (95% CI, 29.8 to 34.2) per 1,000 ventilation-days in each group, respectively. Attributable mortality at 90 days was 3.15% (95%, CI, 2.04% to 3.43%), 2.91% (95% CI, −0.21% to 5.02%), and 8.13% (95% CI, 3.54% to 12.24%), and attributable fraction of mortality at 90 days was 1.22% (95% CI, 0.83 to 1.63), 1.42% (95% CI, −0.11% to 2.61%), and 9.17% (95% CI, 3.54% to 12.24%) for the control, PandeCOV − , and PandeCOV + groups, respectively. Except for the higher risk of developing VAP, the PandeCOV − group shared similar VAP characteristics with the control group. PandeCOV + patients were at lower risk of death without VAP (hazard ratio, 0.62; 95% CI, 0.52 to 0.74) than the control group. Conclusions VAP-attributable mortality was higher for patients with COVID-19, with more than 9% of the overall mortality related to VAP.

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The population-attributable fraction (PAF) quantifies the public health impact of a harmful exposure. Despite being a measure of significant importance, an estimand accommodating complicated time-to-event data is not clearly defined.We discuss current estimands of the PAF used to quantify the public health impact of an internal time-dependent exposure for data subject to competing outcomes. To overcome some limitations, we proposed a novel estimand that is based on dynamic prediction by landmarking. In a profound simulation study, we discuss interpretation and performance of the various estimands and their estimators. The methods are applied to a large French database to estimate the health impact of ventilator-associated pneumonia for patients in intensive care.

Ventilator-associated pneumonia incidence is lower but did not decrease over time in very old patients compared with young patients.