Abstract
BackgroundHospitalized patients with COVID-19 admitted to the intensive care unit (ICU) and requiring mechanical ventilation are at risk of ventilator-associated bacterial infections secondary to SARS-CoV-2 infection. Our study aimed to investigate clinical features of Staphylococcus aureus ventilator-associated pneumonia (SA-VAP) and, if bronchoalveolar lavage samples were available, lung bacterial community features in ICU patients with or without COVID-19.MethodsWe prospectively included hospitalized patients with COVID-19 across two medical ICUs of the Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy), who developed SA-VAP between 20 March 2020 and 30 October 2020 (thereafter referred to as cases). After 1:2 matching based on the simplified acute physiology score II (SAPS II) and the sequential organ failure assessment (SOFA) score, cases were compared with SA-VAP patients without COVID-19 (controls). Clinical, microbiological, and lung microbiota data were analyzed.ResultsWe studied two groups of patients (40 COVID-19 and 80 non-COVID-19). COVID-19 patients had a higher rate of late-onset (87.5% versus 63.8%; p = 0.01), methicillin-resistant (65.0% vs 27.5%; p < 0.01) or bacteremic (47.5% vs 6.3%; p < 0.01) infections compared with non-COVID-19 patients. No statistically significant differences between the patient groups were observed in ICU mortality (p = 0.12), clinical cure (p = 0.20) and microbiological eradication (p = 0.31). On multivariable logistic regression analysis, SAPS II and initial inappropriate antimicrobial therapy were independently associated with ICU mortality. Then, lung microbiota characterization in 10 COVID-19 and 16 non-COVID-19 patients revealed that the overall microbial community composition was significantly different between the patient groups (unweighted UniFrac distance, R2 0.15349; p < 0.01). Species diversity was lower in COVID-19 than in non COVID-19 patients (94.4 ± 44.9 vs 152.5 ± 41.8; p < 0.01). Interestingly, we found that S. aureus (log2 fold change, 29.5), Streptococcus anginosus subspecies anginosus (log2 fold change, 24.9), and Olsenella (log2 fold change, 25.7) were significantly enriched in the COVID-19 group compared to the non–COVID-19 group of SA-VAP patients.ConclusionsIn our study population, COVID-19 seemed to significantly affect microbiological and clinical features of SA-VAP as well as to be associated with a peculiar lung microbiota composition.
Highlights
Since its first detection in China, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)caused pneumonia, known as coronavirus disease 2019 (COVID-19), has become an unprecedented global pandemic [1]
Rate of septic shock, acute kidney injury requiring renal replacement therapy, duration of intensive care unit (ICU) stay, and use of mechanical ventilation before Staphylococcus aureus (SA)-Ventilator-associated pneumonia (VAP) were similar in both groups
In addition to Peptoniphilus (log2 fold change, 24.6), Prevotella 7 (log2 fold change, 22.7), and Bifidobacterium dentium (log2 fold change, 21.3), we found that Staphylococcus aureus (log2 fold change, 29.5), Streptococcus anginosus subspecies anginosus (log2 fold change, 24.9), and Olsenella (log2 fold change, 25.7) were significantly enriched in the COVID-19 group compared to the non–COVID-19 group of Staphylococcus aureus ventilator-associated pneumonia (SA-VAP) patients (Fig. 3)
Summary
Since its first detection in China, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)caused pneumonia, known as coronavirus disease 2019 (COVID-19), has become an unprecedented global pandemic [1]. Many SARS-CoV-2 infected individuals undergo a mild disease [2], a significant proportion of hospitalized patients require admission to the intensive care unit (ICU) [3]. In this setting [4], mechanical ventilation (MV) is commonly used to provide supportive care [5], especially in patients with acute respiratory distress syndrome (ARDS), which is a well-established feature of COVID-19 pathophysiology [6]. Hospitalized patients with COVID-19 admitted to the intensive care unit (ICU) and requiring mechanical ventilation are at risk of ventilator-associated bacterial infections secondary to SARS-CoV-2 infection. Our study aimed to investigate clinical features of Staphylococcus aureus ventilator-associated pneumonia (SA-VAP) and, if bronchoalveolar lavage samples were available, lung bacterial community features in ICU patients with or without COVID-19
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
