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

Daniele Roberto Giacobbe ,Massimo Girardis ,Iole Brunetti ,Novella Carannante ,Stefano Di Bella ,Antonio Di Biagio ,Lucia Taramasso ,Michele Mirabella ,Linda Bussini ,Irene Coloretti ,Paolo Pelosi ,Emanuela Biagioni ,Fiorentino Fraganza ,Erik Roman-Pognuz ,Luca Monastra ,Laura Magnasco ,Giacomo Paluzzano ,V Marco Ranieri ,Francesco Giuseppe De Rosa ,Giorgia Montrucchio ,Giacomo Fornaro ,Tommaso Tonetti ,Michele Bartoletti ,Matteo Rinaldi ,Denise Battaglini ,Maddalena Giannella ,Giuseppe Fiorentino ,Silvia Corcione ,Pierluigi Viale ,Renato Pascale ,Andrea De Maria ,Nicolò Patroniti ,Antonio Corcione ,Francesco Menichetti ,Marco Falcone ,Antonio Vena ,Chiara Robba ,Elisa Martina Enrile ,Chiara Dentone ,Lorenzo Ball ,Alberto Enrico Maraolo ,Giusy Tiseo ,Małgorzata Mikulska ,Matteo Bassetti

doi:10.3390/jcm10040555

Abstract

The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16–21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were Pseudomonas aeruginosa (27/77, 35%) and Staphylococcus aureus (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43–7.61, p = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05–57.26, p < 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases.

Highlights

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19)
COVID-19 was as high as 18 events per 1000 ventilator days in intensive care units (ICU), with 30-day fatality of ventilator-associated pneumonia (VAP) being as high as 46%
The incidence rate of VAP we reported in COVID-19 critically ill patients is among the highest when compared to that of 1 to 19 episodes per 1000 ventilator days reported in non-COVID-19 patients [17,18,19,20,21]

Summary

Introduction

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). The clinical presentation of COVID-19 pneumonia includes fever, leukocytosis, severe hypoxemia, bilateral infiltrates, and multisystemic inflammatory syndrome with possible multiorgan failure (MODS-CoV-2) [5,6]. Some COVID-19 patients admitted to the ICU may require mechanical ventilation for a long time, putting them at risk of developing bacterial superinfections, including ventilator-associated pneumonia (VAP), that may contribute to unfavorably influencing prognosis [7,8,9]. A clear picture of the true incidence rate, spectrum of causative agents, and prognostic factors of VAP in COVID-19 patients, which may help in improving its management, is still unavailable. The primary objective of this observational, multicenter study was to assess the incidence rate of VAP in COVID-19 patients. The secondary objective was to assess predictors of 30-day case-fatality of VAP in COVID-19 patients

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