Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease

Abstract

Background Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited. Methods We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS). Results We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS: 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14–2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization. Conclusions In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.

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

“…Therefore, since some patients may have experienced more than one VAP episode, we also cannot exclude an underestimation of the true incidence rate of VAP in critically ill COVID-19 patients. With regard to organisms isolated from deep respiratory specimens in patients with VAP in our series, the higher frequency of Gram-negative bacteria we registered is in line with recent data from other countries [ 22 , 26 , 27 ].…”

Ventilator-associated pneumonia in the era of COVID-19 pandemic: How common and what is the impact?

“…Significant disparities exist in the epidemiology of VAP, arguing for a standardization of definitions. Blonz et al, reported a crude incidence rate of 48.9% [ 1 ] in agreement with incidence rates ranging from 48 to 79% [ 3 – 6 ] in other cohorts. This rate contrasts substantially with the 29% observed in a multicenter study performed during the first COVID-19 wave in Italy [ 7 ].…”

“…The majority of VAPs were diagnosed based on bacteriological analysis from endotracheal aspirates (42.6%) in the study by Blonz et al, similar to the methods chosen by others [ 6 ]. Bronchoalveolar lavage (BAL) accounted for a quarter of sampling technique in COVID-ARDS patients, compared to 60% in non-COVID ARDS, in one study [ 3 ]. Importantly, quantitative distal as well as proximal samples were performed, but some authors only considered distal samples [ 3 , 4 ], and others also included molecular methods [ 5 , 9 ].…”

“…SARS-CoV-2 ARDS patients have different clinical features than other ARDS patients, characterized by more profound hypoxia, and in comparative studies, the duration of mechanical ventilation was twice as long in COVID-19 patients compared with other types of ARDS [ 4 , 5 ]. The extensive use of prone positioning could also have affected VAP incidence, and this therapy has been used in 67–83% of COVID-19 patients, generally twice as often as in influenza ARDS [ 3 , 6 ]. Another difference with COVID-19 is the high risk of initial pulmonary emboli, which could predisposes to pulmonary infarction and secondary superinfections [ 11 ].…”

Increased susceptibility to intensive care unit-acquired pneumonia in severe COVID-19 patients: a multicentre retrospective cohort study

“…Other studies have already reported various frequency rates of ICU-acquired pneumonia in mechanically ventilated COVID-19 patients, with estimated incidence ranging from 16 to 31% in two early reports from China [11,12]. Since then, several studies confirmed this impression [13][14][15][16]. Importantly, an accurate estimation for the cumulative risk of ICU-acquired pneumonia in ventilated patient requires handling two main competing events that are extubation and death to avoid misinterpretation of risks.…”