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 The goal of this study was to assess risk factors of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with SARS-CoV-2 infection.Methods. We conducted a monocenter retrospective study comparing the prevalence 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 hours. 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 prevalence 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 this retrospective case-control study, we evidenced a higher prevalence of VAP and MDR-VAP in C-ARDS than in NC-ARDS, and a lower risk for invasive aspergillosis in the former group.

Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: a multicenter retrospective study in 188 patients in an un-inundated French region

“…Our cohort was quite similar to those of other studies on VAP in COVID-19 patients [9][10][11] [15] and ACURASYS [5]. Our patients were slightly older (63.9 vs. 59 and 58 for PROSEVA [15] and ACURASYS [5], respectively), and the proportion of previously immunocompromised patients was slightly smaller (8.0% vs. 15.0% and 18% for PROSEVA [15] and ACURASYS [5], respectively).…”

“…As in other studies on VAP in COVID-19 patients [9][10][11], immunocompromised patients represented a modest proportion of our severe COVID-19 population. Moreover, immunodeficiency was not associated with the occurrence of VAP in our study.…”

“…In these two retrospective studies, COVID-19 patients were about twice as likely to develop VAP compared to the control populations. Finally, in a monocentric retrospective study, Razazi et al reported a crude incidence of 64% in a cohort of 90 COVID-19 patients [11].…”

“…This hypothesis is primarily supported by the unusual frequency of VAP complications (bacteremia, abscesses and empyema). In previous published studies [9][10][11], abscesses, empyema and bacteremia were not reported.…”

“…The first studies published on this subject seem to confirm that COVID-19 patients are at greater risk of developing VAP [9][10][11]. Nevertheless, the sudden increase in workload in the centers participating in these studies may have had an impact on the incidence of VAP.…”