How common is ventilator-associated pneumonia after coronavirus disease 2019?

Abstract

Purpose of review The first studies on COVID-19 patients with acute respiratory distress syndrome (ARDS) described a high rate of secondary bacterial ventilator-associated pneumonia (VAP). The specificity of VAP diagnoses in these patients are reviewed, including their actual rate. Recent findings Published studies described high rates of bacterial VAP among COVID-19 patients with ARDS, and these VAP episodes are usually severe and of specifically poor prognosis with high mortality. Indeed, Severe acute respiratory syndrome - coronavirus disease 19 (SARS-CoV2) infection elicits alterations that may explain a high risk of VAP. In addition, breaches in the aseptic management of patients might have occurred when the burden of care was heavy. In addition, VAP in these patients is more frequently suspected, and more often investigated with diagnostic tools based on molecular techniques. Summary VAP is frequented and of particularly poor prognosis in COVID-19 patients with ARDS. It can be explained by SARS-CoV-2 pathophysiology, and also breaches in the aseptic procedures. In addition, tools based on molecular techniques allow an early diagnosis and unmask VAP usually underdiagnosed by traditional culture-based methods. The impact of molecular technique-based diagnostics in improving antibacterial therapy and COVID-19 prognosis remain to be evaluated.

Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality—A Multicentric Observational Study from the OutcomeRea Network

“…In our cohort, relapse and superinfection had a cumulative incidence of 45% and 39.5%, respectively, which is particularly high compared to other studies [ 1 , 2 , 4 ]. Surprisingly, the incidence of treatment failure (relapse, superinfection, or death) at Day 60 reached 58.1%, although without adding to the over-risk of death.…”

“…In patients admitted in an intensive care unit (ICU) and ventilated for Acute Respiratory Distress Syndrome (ARDS) due to SARS-CoV-2, ventilator-associated pneumonia (VAP) is a common complication, ranging from 30% to 86% of patients [ 1 , 2 ]. The cumulative incidence among COVID-19 patients can reach approximately 35/1000 ventilator days in European cohorts, which is 50% to 80% higher than in ARDS from other etiologies [ 3 , 4 ].…”

After SARS-CoV-2 Pandemics: New Insights into ICU-Acquired Pneumonia

“…Taken together, recent articles suggest that SARS-CoV-2 patients are at high risk for nosocomial infections compared to other mechanically ventilated patients with or without ARDS. Poor infection control practices, local and systemic immune alterations, extremely long duration of mechanical ventilation, and an extensive use of corticosteroids and immunosuppressive agents probably explain this finding, which has a profound impact on prognosis [ 11 ]. This finding should be taken into account when prioritizing strategies of preparation for future pandemics.…”

Prevention and treatment of ventilator-associated pneumonia in COVID-19

“…During the COVID-19 pandemic, severe COVID-19 patients were admitted to ICUs, received mechanical ventilation ( Chang et al, 2021 ; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators, 2021 ), and have a high incidence of VAP ( Ippolito et al, 2021 ; Wicky et al, 2022 ).…”

“…The widespread use of new molecular technology effectively alleviates this problem and contributes to the increasing incidence of VAP. Tools based on multiplex polymerase chain reaction make it possible to diagnose early VAP and identify VAP usually underdiagnosed by conventional culture-based methods ( Cohen et al, 2021 ; Wicky et al, 2022 ). It has been reported in the literature, the combination of sequential PCR and electrospray ionization mass spectrometry was a potential rapid technique to diagnose VAP within 6 h ( Hou et al, 2020 ).…”