Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation

Abstract

(1) Background: Few reports of necrotizing pneumonia in patients with COVID-19 have been published. We have observed an elevated incidence at two hospitals in our city, suggesting this complication is not uncommon, and may have been overlooked. (2) Methods: This article presents a retrospective, descriptive cohort study that was undertaken from 22 March 2020 to 15 June 2021 in two tertiary care hospitals in Medellín, Colombia. All adult patients admitted to the intensive care unit (ICU) for respiratory failure related to confirmed COVID-19, on invasive mechanical ventilation (IMV), with imaging or surgical findings documenting necrotizing pneumonia (NP) were included. (3) Results: Of 936 patients with COVID-19 that required IMV, 42 (4.5%) developed NP. Overall mortality was 57% and in-hospital mortality was 71%, occurring 15–79 days after COVID-19 diagnosis. NP was diagnosed at a median of 27 days after COVID-19 symptom onset and 15.5 days after initiation of IMV. Infections were polymicrobial in 52.4% of patients. Klebsiella pneumoniae (57%) and Pseudomonas aeruginosa (33%) were the most common etiologic agents. Pulmonary embolism (PE) was documented in 13 patients overall (31%), and in 50% of patients who underwent an angioCT. Drainage and/or surgical procedures were performed on 19 patients (45.2%) with a 75% mortality rate. (4) Conclusions: In our experience, NP is a relatively common, albeit neglected, complication in mechanically ventilated COVID-19 patients, possibly originating in poorly vascularized areas of lung parenchyma. Associated mortality is high. Although drainage procedures did not seem to favorably impact patient outcomes, diagnosis and treatment were late events in the overall disease course, suggesting that early recognition and timely treatment could have a positive impact on prognosis.

Lung Abscess as a Delayed Complication in a COVID-19 Pneumonia Patient: A Case Report

“…13,14 In this case, no bacterial growth was detected via bacterial culture study; therefore, we used an empirical approach to treatment. 15,16 Advanced age, alcoholism, diabetes mellitus, immunosuppression, poor oral hygiene, mental retardation, and coma may all affect the development of lung abscesses. 17,18 Aside from having a COVID-19 infection, the patient had no other risk factors that could cause an abscess.…”

Atypical Hemolytic Uremic Syndrome and Super-infection after COVID-19

“…During COVID-19 most of NP occur as a late complication of COVID-19 mainly due to Klebsiella pneumonia and Pseudomonas aeruginosa super-infection without significant AKI occurrence or atypical HUS in affected cases. [6] Acute renal failure is not a prominent event after super-infection following COVID-19 and atypical HUS is a rare event during COVID-19 mostly unknown in origin and non-related to streptococcal pneumonia especially in adults. Necrotizing pneumonia is a complication which occurs along with atypical HUS due to streptococcal pneumonia but it can be seen during COVID-19 mostly related to other infections such as Klebsiella and Pseudomona.…”

Necrotizing pneumonia due to Pseudomonas aeruginosa secondary to severe COVID-19 pneumonia

“…3 In patients with COVID-19 pneumonia on invasive mechanical ventilation, the incidence of NP ranges from less than 0.5% 4 to 4.5%, and Klebsiella pneumoniaeand P. aeruginosa are the most common pathogens. 5 A retrospective study reported NP was diagnosed at a median of 27 days after COVID-19 symptom onset. 5 This case illustrates that NP can occur as a secondary infection even if the clinical course of COVID-19 pneumonia is favorable, particularly in patients on invasive mechanical ventilation.…”

“…5 A retrospective study reported NP was diagnosed at a median of 27 days after COVID-19 symptom onset. 5 This case illustrates that NP can occur as a secondary infection even if the clinical course of COVID-19 pneumonia is favorable, particularly in patients on invasive mechanical ventilation. (d-f) Chest computed tomography findings on hospital day 12 showing multiple thick-walled cavities with patchy shadows and ground-glass opacities detected as new findings, with near-complete resolution of the bilateral ground-grass opacities and consolidation detected on admission.…”