Ventilator-Associated Pneumonia in COVID-19 Patients: A Retrospective Cohort Study

Rouyer, M.; Strazzulla, Alessio; Youbong, Tracie Joyner; Tarteret, Paul; Pitsch, A.; Pontfarcy, A. de; Cassard, Bruno; Vignier, Nicolas; Pourcine, Franck; Jochmans, Sébastien; Monchi, Mehran; Diamantis, S.

doi:10.3390/antibiotics10080988

Cited by 28 publications

(24 citation statements)

References 31 publications

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“…However, the evidence from this trial, although not adequately powered, suggests potential beneficial effects of inhalation therapy on the incidence of Gram-positive bacterial VAP, a finding which should be confirmed in further studies. Although the most common causes of VAP are Gram-negative bacteria, MRSA causes approximately 7% of VAP [42][43][44]. The present study found even higher incidence of MRSA VAP in the control group (up to 35%), highlighting the importance of this pathogen in critically ill COVID-19 patients.…”

Section: Discussionsupporting

confidence: 46%

Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial

et al. 2022

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The effect of routine inhalation therapy on ventilator-associated pneumonia (VAP) in mechanically ventilated patients with the coronavirus disease (COVID-19) has not been well-defined. This randomized controlled trial included 175 eligible adult patients with COVID-19 who were treated with mechanical ventilation at the University Hospital of Split between October 2020 and June 2021. Patients were randomized and allocated to a control group (no routine inhalation) or one of the treatment arms (inhalation of N-acetylcysteine; 5% saline solution; or 8.4% sodium bicarbonate). The primary outcome was the incidence of VAP, while secondary outcomes included all-cause mortality. Routine inhalation therapy had no effect on the incidence of bacterial or fungal VAP nor on all-cause mortality (p > 0.05). Secondary analyses revealed a significant reduction of Gram-positive and methicillin-resistant Staphylococcus aureus (MRSA) VAP in the treatment groups. Specifically, the bicarbonate group had a statistically significantly lower incidence of Gram-positive bacterial VAP (4.8%), followed by the N-acetylcysteine group (10.3%), 5% saline group (19.0%), and control group (34.6%; p = 0.001). This difference was driven by a lower incidence of MRSA VAP in the bicarbonate group (2.4%), followed by the N-acetylcysteine group (7.7%), 5% saline group (14.3%), and control group (34.6%; p < 0.001). Longer duration of ventilator therapy was the only significant, independent predictor of any bacterial or fungal VAP in the multivariate analysis (aOR 1.14, 95% CI 1.01–1.29, p = 0.038 and aOR 1.05, 95% CI 1.01–1.10, p = 0.028, respectively). In conclusion, inhalation therapy had no effect on the overall VAP incidence or all-cause mortality. Further studies should explore the secondary findings of this study such as the reduction of Gram-positive or MRSA-caused VAP in treated patients.

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Section: Discussionsupporting

confidence: 46%

Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial

et al. 2022

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“…How do we reconcile the various previous studies that have reported a significant increase in VAP rates in patients with COVID-19 (2)(3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(14) with this finding of no increase from Hedberg et al (9)? The first explanation may be related to the very high rate of VA-LRTI in the control arm of Hedberg et al (9) study: 34 per 1,000 ventilation-days, compared with lower control arm rates from previous studies: 13 per 1,000 ventilation-days (3) and 15 per 1,000 ventilation-days (2), which indicates that Hedberg et al (9) reported more than double the control baseline rate of other studies; thus, if patients without COVID-19 were already at such a high risk for VAP (9), it might have become not feasible to detect any VAP rate difference compared with patients with COVID-19.…”

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confidence: 49%

The Puzzles of Ventilator-Associated Pneumonia and COVID-19: Absolute Knowns and Relative Unknowns*

Ryder

Kalil

2022

Critical Care Medicine

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T he development of ventilator-associated pneumonia (VAP) (1) in ICU patients with severe COVID-19 is common and associated with higher VAP rates compared with non-COVID-19 patients in several retrospective studies (2-6). Additionally, there is an increased risk of shock and blood stream infections associated with VAP in .A challenge in understanding the reason for this increased rate is the lack of a clear definition of VAP in COVID-19. Due to the frequent concomitant presence of fever, leukocytosis, and lung infiltrates due to the viral infection, differentiating bacterial colonization from a new bacterial secondary infection is challenging in the presence of these symptoms and imaging findings of an acute viral pneumonia. In part due to these challenges, the term ventilator-associated lower respiratory tract infection (VA-LRTI) has been used: the rate of VA-LRTI has also been found to be higher in ICU patients with COVID-19 compared with ICU patients with influenza and those without viral infection (7).A key remaining question is why VAP and VA-LRTI occur at higher rates in COVID-19 patients. Proposed reasons for increased rate of VAP and VA-LRTI in COVID-19 include viral immunomodulation, prolonged mechanical ventilation and hospital stay, steroids use, acute respiratory distress syndrome (ARDS), prone positioning, sedating and neuromuscular blocking agents, vasopressor use, extracorporeal mechanical oxygenation utilization, and increased demands of the healthcare system including patient volume, healthcare worker shortages, and use of personal protective equipment (8). Prior studies have not systematically evaluated how VA-LRTI has changed throughout the pandemic.In this issue of Critical Care Medicine, Hedberg et al ( 9) expand on the epidemiology of VA-LRTIs in COVID-19 using a retrospective analysis of ventilated adults in a large Swedish ICU from January 2011 to December 2020. Their primary goal was to evaluate changes in rate of VA-LRTI in COVID-19 compared with non-COVID-19 patients over time. Specifically, they compared COVID-19 patients with non-COVID-19 patients (including influenza and the 10 most common International Classification of Diseases, 10th Edition ICU diagnoses during and prior to the pandemic) and then performed a second analysis comparing the first wave of the COVID-19 pandemic (March-July 2020) with the second wave (October-December 2020).The cohort included 479 COVID-19 ICU episodes and 19,744 non-COVID-19 ICU episodes. Patients with COVID-19 were younger and had

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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%

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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Ventilator-Associated Pneumonia in COVID-19 Patients: A Retrospective Cohort Study

Cited by 28 publications

References 31 publications

Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial

Effects of Different Inhalation Therapy on Ventilator-Associated Pneumonia in Ventilated COVID-19 Patients: A Randomized Controlled Trial

The Puzzles of Ventilator-Associated Pneumonia and COVID-19: Absolute Knowns and Relative Unknowns*

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

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