Abstract
BackgroundThe data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited. We performed this retrospective cohort study to assess frequency, clinical characteristics, responsible pathogens, and outcomes of VAP in patients COVID-19 pneumonia requiring MV between March 12th and April 24th, 2020 (all had RT-PCR-confirmed SARS-CoV-2 infection). Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring ECMO were compared with an historical cohort of 45 patients with severe influenza-associated ARDS requiring ECMO admitted to the same ICU during the preceding three winter seasons.ResultsAmong 50 consecutive patients with Covid-19-associated ARDS requiring ECMO included [median (IQR) age 48 (42–56) years; 72% male], 43 (86%) developed VAP [median (IQR) MV duration before the first episode, 10 (8–16) days]. VAP-causative pathogens were predominantly Enterobacteriaceae (70%), particularly inducible AmpC-cephalosporinase producers (40%), followed by Pseudomonas aeruginosa (37%). VAP recurred in 34 (79%) patients and 17 (34%) died. Most recurrences were relapses (i.e., infection with the same pathogen), with a high percentage occurring on adequate antimicrobial treatment. Estimated cumulative incidence of VAP, taking into account death and extubation as competing events, was significantly higher in Covid-19 patients than in influenza patients (p = 0.002). Despite a high P. aeruginosa-VAP rate in patients with influenza-associated ARDS (54%), the pulmonary infection recurrence rate was significantly lower than in Covid-19 patients. Overall mortality was similar for the two groups.ConclusionsPatients with severe Covid-19-associated ARDS requiring ECMO had a very high late-onset VAP rate. Inducible AmpC-cephalosporinase-producing Enterobacteriaceae and Pseudomonas aeruginosa frequently caused VAP, with multiple recurrences and difficulties eradicating the pathogen from the lung.
Highlights
The data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited
We conducted a retrospective study to evaluate VAP frequency, characteristics and outcomes for all patients sequentially admitted to our Intensive care unit (ICU) (a tertiary referral center for extracorporeal membrane oxygenation (ECMO)) for virologically confirmed Covid-19 acute respiratory distress syndrome (ARDS) requiring Extracorporeal membrane oxygenation (ECMO) between 12 March and 24 April 2020, and compared their data with those obtained from a historical cohort of patients with influenza-associated ARDS requiring ECMO
Patients All consecutive ICU-admitted patients, with reversetranscriptase-polymerase-chain reaction-confirmed Covid-19 pneumonia, based on a respiratory specimen, between 12 March and 24 April 2020, having developed ARDS according to the Berlin definition [7] and requiring ECMO, were included
Summary
The data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited We performed this retrospective cohort study to assess frequency, clinical characteristics, responsible patho‐ gens, and outcomes of VAP in patients COVID-19 pneumonia requiring MV between March 12th and April 24th, 2020 (all had RT-PCR-confirmed SARS-CoV-2 infection). We conducted a retrospective study to evaluate VAP frequency, characteristics and outcomes for all patients sequentially admitted to our ICU (a tertiary referral center for extracorporeal membrane oxygenation (ECMO)) for virologically confirmed Covid-19 ARDS requiring ECMO between 12 March and 24 April 2020, and compared their data with those obtained from a historical cohort of patients with influenza-associated ARDS requiring ECMO Owing to Covid-19’s particular pathophysiology, with some evidence of prolonged immunocompromised status including profound lymphopenia [3], and the potential use of glucocorticoids or immunosuppressants to treat Covid-19 patients [4, 5], we hypothesized that such patients would frequently develop VAP and that they would have worse outcomes than patients with ARDS of other causes, especially higher rates of clinical failure and VAP recurrence [6].
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