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

Gauthier Blonz,Lucie Planche,Nicolas Chudeau,Anthony Lemeur,Emmanuel Pontis,Jean-Baptiste Lascarrou,Julien Lorber,Achille Kouatchet,Gwenhael Colin

doi:10.1186/s13054-021-03493-w

Abstract

BackgroundThe COVID-19 pandemic is responsible for many hospitalizations in intensive care units (ICU), with widespread use of invasive mechanical ventilation (IMV) which exposes patients to the risk of ventilator-associated pneumonia (VAP). The characteristics of VAP in COVID-19 patients remain unclear.MethodsWe retrospectively collected data on all patients hospitalized for COVID-19 during the first phase of the epidemic in one of the seven ICUs of the Pays-de-Loire region (North-West France) and who were on invasive mechanical ventilation for more than 48 h. We studied the characteristics of VAP in these patients. VAP was diagnosed based on official recommendations, and we included only cases of VAP that were confirmed by a quantitative microbiological culture.FindingsWe analyzed data from 188 patients. Of these patients, 48.9% had VAP and 19.7% experienced multiple episodes. Our study showed an incidence of 39.0 VAP per 1000 days of IMV (until the first VAP episode) and an incidence of 33.7 VAP per 1000 days of IMV (including all 141 episodes of VAP). Multi-microbial VAP accounted for 39.0% of all VAP, and 205 pathogens were identified. Enterobacteria accounted for 49.8% of all the isolated pathogens. Bacteremia was associated in 15 (10.6%) cases of VAP. Pneumonia was complicated by thoracic empyema in five cases (3.5%) and by pulmonary abscess in two cases (1.4%). Males were associated with a higher risk of VAP (sHR 2.24 CI95% [1.18; 4.26] p = 0.013).InterpretationOur study showed an unusually high incidence of VAP in patients admitted to the ICU for severe COVID-19, even though our services were not inundated during the first wave of the epidemic. We also noted a significant proportion of enterobacteria. VAP-associated complications (abscess, empyema) were not exceptional.RegistrationAs an observational study, this study has not been registered.

Highlights

The COVID-19 pandemic is responsible for many hospitalizations in intensive care units (ICU), with widespread use of invasive mechanical ventilation (IMV) which exposes patients to the risk of ventilator-associated pneumonia (VAP)
Interpretation: Our study showed an unusually high incidence of VAP in patients admitted to the ICU for severe COVID-19, even though our services were not inundated during the first wave of the epidemic
All patients diagnosed with COVID-19, who were admitted to all the ICUs in the Pays-de-la-Loire region between March 1, 2020, and May 18, 2020, were screened

Summary

Introduction

The COVID-19 pandemic is responsible for many hospitalizations in intensive care units (ICU), with widespread use of invasive mechanical ventilation (IMV) which exposes patients to the risk of ventilator-associated pneumonia (VAP). Blonz et al Crit Care (2021) 25:72 impairment develop a severe form with acute respiratory failure and require specialized management in the intensive care unit (ICU). The characteristics are comparable for the majority of patients, who develop an acute respiratory distress syndrome (ARDS) with ground-glass X-ray opacities and a very intense systemic inflammatory response syndrome [2]. Since a few weeks after the beginning of March 2020, several thousand people have been receiving invasive mechanical ventilation (IMV) in France due to severe COVID-19. IMV exposes patients to a particular risk of a nosocomial infectious complication called ventilator-associated pneumonia (VAP) [3]. In Europe, the incidence density is 18.3 VAP per 1000 days of IMV [4]

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