Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study

Giacobbe, Daniele Roberto; Battaglini, Denise; Enrile, Elisa Martina; Dentone, Chiara; Vena, Antonio; Robba, Chiara; Ball, Lorenzo; Bartoletti, Michele; Coloretti, Irene; Bella, Stefano Di; Biagio, Antonio Di; Brunetti, Iole; Mikulska, Małgorzata; Carannante, Novella; Maria, Andrea De; Magnasco, Laura; Maraolo, Alberto Enrico; Mirabella, Michele; Montrucchio, Giorgia; Patroniti, Nicolò; Taramasso, Lucia; Tiseo, Giusy; Fornaro, Giacomo; Fraganza, Fiorentino; Monastra, Luca; Roman-Pognuz, Erik; Paluzzano, Giacomo; Fiorentino, Giuseppe; Corcione, Antonio; Bussini, Linda; Pascale, Renato; Corcione, Silvia; Tonetti, Tommaso; Rinaldi, Matteo; Falcone, Marco; Biagioni, Emanuela; Ranieri, V. Marco; Giannella, Maddalena; Rosa, Francesco Giuseppe De; Girardis, Massimo; Menichetti, Francesco; Viale, Pierluigi; Pelosi, Paolo; Bassetti, Matteo

doi:10.3390/jcm10040555

Cited by 112 publications

(114 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Eleven of the included studies reported data on mortality in patients with COVID-19 and VAP [ 9 , 15 , 16 , 20 , 21 , 23 , 24 , 25 , 30 , 31 , 32 ]. The pooled estimated occurrence of mortality (at the longest available follow-up) was 42.7% (95% C.I.…”

Section: Resultsmentioning

confidence: 99%

“…The severity of lung damage in patients with COVID-19 pneumonia may lead to an increase in the rate of infections. Furthermore, patients with COVID-19 frequently needed prolonged mechanical ventilation, prone positioning [ 1 ] and received immunomodulant therapies, that may have increased their risk of developing VAP [ 9 ]. On the other hand, the ICUs may have been overcrowded in the period of peak of COVID-19 pandemic, with a possibly inadequate staffing (e.g., nurse to patient ratio) and more episodes of cross-contaminations.…”

Section: Discussionmentioning

confidence: 99%

“…The full search output is available as Supplementary Material S3. After the exclusion of duplicates and not relevant records, twenty studies were included in the systematic review and metaanalysis, for a total of 2611 patients with COVID-19 who developed at least one episode of VAP [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The process of inclusion and exclusion is detailed in the PRISMA flow diagram, provided in Figure 1.…”

Section: Characteristics Of Included Studies and Patientsmentioning

confidence: 99%

“…The clinical course of patients with the most severe form of COVID-19 in ICU may be complicated by the need for extracorporeal membrane oxygenation [ 8 ]. Other factors, such as the lung damage itself and the use of immunomodulant therapies (e.g., corticosteroids, anti-il-6 drugs) may also increase the risk of VAP in these cohorts of patients [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of ventilator-associated pneumonia (VAP) among patients admitted to an intensive care unit with COVID-19 and mortality of those who developed VAP. We performed a systematic search on PubMed, EMBASE and Web of Science from inception to 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult patients with COVID-19 and reporting data on at least one primary outcome of interest. Random effect single-arm meta-analysis was performed for the occurrence of VAP and mortality (at the longest follow up) and ICU length of stay. Twenty studies were included in the systematic review and meta-analysis, for a total of 2611 patients with at least one episode of VAP. The pooled estimated occurrence of VAP was of 45.4% (95% C.I. 37.8–53.2%; 2611/5593 patients; I2 = 96%). The pooled estimated occurrence of mortality was 42.7% (95% C.I. 34–51.7%; 371/946 patients; I2 = 82%). The estimated summary estimated metric mean ICU LOS was 28.58 days (95% C.I. 21.4–35.8; I2 = 98%). Sensitivity analysis showed that patients with COVID-19 may have a higher risk of developing VAP than patients without COVID-19 (OR 3.24; 95% C.I. 2.2–4.7; P = 0.015; I2 = 67.7%; five studies with a comparison group).

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Characteristics Of Included Studies and Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…( 22 ) S. aureus has been reported as a frequently-isolated organism from deep respiratory specimens taken from critically-ill COVID-19 patients with VAP. ( 23 ).…”

Section: Covid-19 and Antibiotic-resistant Healthcare-associated Infectionsmentioning

confidence: 99%

The interface between COVID-19 and bacterial healthcare-associated infections

O'Toole

2021

Clinical Microbiology and Infection

121

View full text Add to dashboard Cite

Background A wide range of bacterial infections occur in COVID-19 patients, particularly, in those with severe coronaviral disease. Some of these are community acquired co-infections. Objective To review recent data which indicate the occurrence of hospital-onset bacterial infections, including with antibiotic-resistant isolates, in COVID-19 patients. Sources Using PubMed, the literature was searched using terms including: “COVID-19”; “SARS-CoV-2”; “bacterial infection”; “healthcare-associated infection”; “antibiotic resistance”; “antimicrobial resistance”; “multi-drug resistance”; “ Streptococcus ”; “ Staphylococcus ”; “ Pseudomonas ”; “ Escherichia ”; “ Klebsiella ”; “ Enterococcus ”; “ Acinetobacter ”; “ Haemophilus ”; “MRSA”; “VRE”; “ESBL”; “NDM-CRE”; “CR-Ab”; “VRSA”; “MDR”. Content There is a growing number of reports of bacterial infections acquired by patients with severe COVID-19 after hospital admission. Antibiotic-resistant pathogens found to cause healthcare-associated infections (HAIs) in COVID-19 patients include Methicillin-Resistant Staphylococcus aureus (MRSA), New Delhi Metallo-β-lactamase-producing Carbapenem-Resistant Enterobacterales (NDM-CRE), Carbapenem-Resistant Acinetobacter baumannii (CR-Ab), Extended-Spectrum β-Lactamase (ESBL) Klebsiella pneumoniae , and Vancomycin-Resistant Enterococci (VRE). COVID-19 has impacted bacterial HAIs in a number of ways with an increase in the incidence of NDM-CRE and CR-Ab reported at some hospital sites compared to before the pandemic. Recommended guidelines for antimicrobial stewardship in COVID-19 patient treatment are discussed regarding minimisation of empiric broad-spectrum antibiotic use. Other studies have reported a decrease in MRSA and VRE cases that has been attributed to enhanced infection prevention and control (IPC) practices introduced to minimise intra-hospital spread of COVID-19. Implications Poorer outcomes have been observed in hospitalised COVID-19 patients with an antibiotic-resistant infection. While heightened IPC measures have been accompanied by a reduction in some HAIs at specific sites, in other situations, COVID-19 has been associated with an increase in bacterial HAI incidence. Further research is needed to define the cost-benefit relationship of maintaining COVID-19-related IPC protocols beyond the pandemic to reduce the burden of HAIs. In addition, the longer-term impact of high usage of certain broad-spectrum antibiotics during the COVID-19 pandemic requires evaluation.

show abstract