Multidrug-resistant VAP before and during the COVID-19 pandemic among hospitalized patients in a tertiary private hospital

Abstract

Background: There is limited data on ventilator-associated pneumonia (VAP) and multidrug-resistant VAP (MDR VAP) among COVID-19 patients. Methods: A retrospective study in a single, tertiary, private hospital in the Philippines was conducted comparing the incidence, profile, and patient outcomes of MDR VAP during the pre-COVID-19 (2018–2019) and COVID-19 (2020–2021) periods. Results: In total, 80/362 (22%) patients developed VAP, 27/204 (33.75%) from pre-COVID-19 and 53/158 (66.25%) from the COVID-19 period, respectively. The majority were male [20/27 (74%) vs 34/53 (64%)], with a median age of 66 (range 35–90) and 67 (range 32–92) years in each period, respectively. Comorbidities were similar, except cardiovascular disease (14/27 vs 11/53 patients, p-value 0.005) and chronic lung disease (14/27 vs 9/53 patients, p-value 0.0012). VAP incidence density was 19.3/1000 and 27.8/1000 ventilator days (p-value 0.9819)]; median length of stay before VAP for pre- and COVID-19 periods was 17 and 10 days, respectively (p-value <0.0001). Extended-spectrum β lactamase (ESBL)-producing resistance increased significantly [1/27 (3.7%) pre-COVID-19 vs 15/53 (28.3%)] during COVID-19, while Carbapenem-resistant Enterobacteriaceae resistance was higher in the pre-COVID-19 period (15/27 [56%] vs 10/53 [19%]). Mortality was high in both periods at 93% and 83%, respectively. On multivariate analysis, only female gender was associated with MDR VAP in the COVID-19 period (OR =3.47, [CI 1.019, 11.824], p-value < 0.047). Conclusion: The frequency of VAP and MDR VAP increased during the COVID-19 period, despite a shorter duration of hospital stay. The mortality of VAP was extremely high. Factors associated with increased risk of VAP and COVID-19 need to be studied further, and preventive measures should be prioritized.

Pneumonia Characteristics in an Intensive Care Unit Setting during and after the COVID-19 Pandemic—A Single-Center Prospective Study

“…During the analyzed period, VAP occurred more frequently in the group of patients with pneumonia caused by COVID-19 than in patients without COVID-19 (52/234, 22.1% vs. 180/1506, 11.95%; p = 0.000). This corresponds to the findings of other research where the incidence density of VAP during the COVID-19 period exceeded that of the pre-COVID-19 period (19.3 vs. 27.8 per 1000 VD); however, no statistical significance was found [38].…”

Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review

“…Another important fact raised by recent literature is that pathogens causing VAP can vary depending on some other cumulative risk factors, such as length of stay in the ICU, length of hospitalization, previous exposure to antibiotic treatment, local microbial ecology and timing of ventilatory support [ 19 , 20 ]. Precisely, it is generally accepted that early-onset ventilator-associated pneumonia, which occurs within the first 4 days of ventilatory support, is usually caused by non-multidrug resistant (non-MDR) pathogens, which can be found in the common oropharyngeal flora; in comparison, in the late-onset type, which occurs after at least 5 days of ventilatory support, pathogens are commonly multidrug resistant (MDR) [ 8 , 21 ].…”

“…Conventionally, diagnosing VAP using clinical findings can be challenging due to the non-specific signs and symptoms found in a critically ill patient, this being the reason why authors generally recommend a complex clinical approach. Therefore, most patients suspected of having VAP usually present with the following clinical features after at least 48 h from endotracheal intubation and mechanical ventilation: new and progressive infiltrates on the chest radiography or computed tomography scan, plus at least two of the following features, those being new onset of fever (more than 38 • C), altered value of white blood cell count (leukocytosis > 12.000 cells/mm 3 or leukopenia < 4000 cells/mm 3 ) and the presence of purulent secretions [19]. Some studies also included other clinical findings, such as hypoxemia, tachypnea, hemoptysis, crackles and altered ventilator parameters which increased inspiratory pressures with low tidal volumes [27].…”