Increased Incidence of Ventilator-Acquired Pneumonia in Coronavirus Disease 2019 Patients: A Multicentric Cohort Study*

Vacheron, Charles-Hervé; Lepape, Alain; Savey, Anne; Machut, Anaïs; Timsit, Jean François; Vanhems, Philippe; Le, Quoc Viet; Egbeola, Julia; Martin, Maëlle; Maxime, Virginie; Pugliesi, Paul-Simon; Maucort‐Boulch, Delphine; Friggeri, Arnaud

doi:10.1097/ccm.0000000000005297

Cited by 41 publications

(44 citation statements)

References 31 publications

(37 reference statements)

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“…The reported incidence of ventilator-associated pneumonia (VAP) in COVID-19 ARDS, ranges from 25 to almost 85%, and represents twice as many complications as in control ARDS patients without COVID-19 (Table 1 ) [ 3 ]. In COVID-19 patients, VAP occurred earlier than in other mechanically ventilated patients [ 4 ]. Despite a relatively low rate of bacterial coinfection [ 5 , 6 , 7 ▪ ], patients with COVID-19 pneumonia frequently receive antimicrobial therapy.…”

Section: Incidence Of Ventilator-associated Pneumonia In Coronavirus ...mentioning

confidence: 99%

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

Wicky

d’Humières

Timsit

2022

Current Opinion in Infectious Diseases

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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.

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Section: Incidence Of Ventilator-associated Pneumonia In Coronavirus ...mentioning

confidence: 99%

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

Wicky

d’Humières

Timsit

2022

Current Opinion in Infectious Diseases

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“…After excluding 632 due to duplication or because they did not meet the inclusion criteria based on the title and abstract, we found 60 relevant articles that were considered for full-text review and eligibility. Finally, 25 articles that met the criteria were included in this systematic review [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The flow chart of the systematic literature search according to PRISMA guidelines is shown in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Most studies did not report the resistance patterns of this microorganism. Vacheron et al [ 37 ] reported resistance to carbapenems in 42 (21.5%) of 195 P. aeruginosa isolated from VAP cases, and another study found that all isolated P. aeruginosa had an ESBL resistance pattern [ 19 ]. VAP caused by Enterobacter cloacae was reported in 11 (44%) of the studies.…”

Section: Resultsmentioning

confidence: 99%

Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review

et al. 2022

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Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents of VAP and resistance to antibiotics in COVID-19 patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, and LILACS databases from December 2019 to December 2021. Studies that described the frequency of causative pathogens associated with VAP and their antibiotic resistance patterns in critically ill COVID-19 adult patients were included. The Newcastle-Ottawa Quality Assessment Scale was used for critical appraisal. The data are presented according to the number or proportions reported in the studies. A total of 25 articles were included, involving 2766 VAP cases in COVID-19 patients (range 5–550 VAP cases). Most of the studies included were carried out in France (32%), Italy (20%), Spain (12%) and the United States (8%). Gram-negative bacteria were the most frequent causative pathogens of VAP (range of incidences in studies: P. aeruginosa 7.5–72.5%, K. pneumoniae 6.9–43.7%, E. cloacae 1.6–20% and A. baumannii 1.2–20%). S. aureus was the most frequent Gram-positive pathogen, with a range of incidence of 3.3–57.9%. The median incidence of Aspergillus spp. was 6.4%. Few studies have recorded susceptibility patterns among Gram-negative causative pathogens and have mainly reported extended-spectrum beta-lactamase (ESBL), AmpC, and carbapenem resistance. The median frequency of methicillin resistance among S. aureus isolates was 44.4%. Our study provides the first comprehensive description of the causative agents and antibiotic resistance in COVID-19 patients with VAP. Gram-negative bacteria were the most common pathogens causing VAP. Data on antibiotic resistance patterns in the published medical literature are limited, as well as information about VAP from low- and middle-income countries.

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“…In addition, the fact most world ICUs have been run close to or at capacity, adds another major risk of hospital-acquired infections like VAP because the lower healthcare provider to patient ratio and the higher need for personal protective equipment (already limited in many hospitals) can further lead to suboptimal infection control measures and its consequent higher incidence of hospital-acquired infections (20). Among the limitations of this new study by Vacheron et al (9), it is notable that there was no collection of concomitant medications, such as steroids, other immunosuppressive drugs, nor the description of hospital/ICU capacity levels at each enrolling site, both of which could have affected the incidence of VAP; for example, the use of concomitant immunosuppressive drugs was likely more frequent in the COVID-19 patients, and this could have further increased the VAP rate in patients with COVID-19. Also, severe lymphopenia due to COVID-19 increases the risk of secondary infections (20,21), and the more frequent use of extracorporeal membrane oxygenation in patients with COVID-19 is also associated with VAP (2,15,22).…”

mentioning

confidence: 90%

Is Ventilator-Associated Pneumonia More Frequent in Patients With Coronavirus Disease 2019?*

Kalil

Cawcutt

2021

Critical Care Medicine

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Mission on Prognosis Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) Study Group; Corticosteroid Randomisation After Significant Head Injury (CRASH) Trial Collaborators; Trauma Audit and Research Network (TARN): Prediction of outcome after moderate and severe traumatic brain injury: External validation of the International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models.

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Increased Incidence of Ventilator-Acquired Pneumonia in Coronavirus Disease 2019 Patients: A Multicentric Cohort Study*

Abstract: 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.

Cited by 41 publications

References 31 publications

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

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

Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review

Is Ventilator-Associated Pneumonia More Frequent in Patients With Coronavirus Disease 2019?*

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