TY - JOUR
T1 - Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections
T2 - a European multicenter cohort study
AU - on behalf of the coVAPid study Group
AU - Rouzé, Anahita
AU - Martin-Loeches, Ignacio
AU - Povoa, Pedro
AU - Makris, Demosthenes
AU - Artigas, Antonio
AU - Bouchereau, Mathilde
AU - Lambiotte, Fabien
AU - Metzelard, Matthieu
AU - Cuchet, Pierre
AU - Boulle Geronimi, Claire
AU - Labruyere, Marie
AU - Tamion, Fabienne
AU - Nyunga, Martine
AU - Luyt, Charles Edouard
AU - Labreuche, Julien
AU - Pouly, Olivier
AU - Bardin, Justine
AU - Saade, Anastasia
AU - Asfar, Pierre
AU - Baudel, Jean Luc
AU - Beurton, Alexandra
AU - Garot, Denis
AU - Ioannidou, Iliana
AU - Kreitmann, Louis
AU - Llitjos, Jean François
AU - Magira, Eleni
AU - Mégarbane, Bruno
AU - Meguerditchian, David
AU - Moglia, Edgar
AU - Mekontso-Dessap, Armand
AU - Reignier, Jean
AU - Turpin, Matthieu
AU - Pierre, Alexandre
AU - Plantefeve, Gaetan
AU - Vinsonneau, Christophe
AU - Floch, Pierre Edouard
AU - Weiss, Nicolas
AU - Ceccato, Adrian
AU - Torres, Antoni
AU - Duhamel, Alain
AU - Nseir, Saad
AU - Favory, Raphaël
AU - Preau, Sébastien
AU - Jourdain, Mercé
AU - Poissy, Julien
AU - Bouras, Chaouki
AU - Saint Leger, Piehr
AU - Fodil, Hanane
AU - Aptel, François
AU - Cilloniz, Catia
N1 - Publisher Copyright:
© 2021, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2021/2
Y1 - 2021/2
N2 - Purpose: Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI. Methods: Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models. Results: 1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp. Conclusions: The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates.
AB - Purpose: Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI. Methods: Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models. Results: 1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp. Conclusions: The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates.
KW - COVID-19
KW - Critical illness
KW - SARS-CoV-2
KW - Ventilator-associated pneumonia
KW - Ventilator-associated tracheobronchitis
UR - https://www.scopus.com/pages/publications/85098496448
U2 - 10.1007/s00134-020-06323-9
DO - 10.1007/s00134-020-06323-9
M3 - Original Article
C2 - 33388794
AN - SCOPUS:85098496448
SN - 0342-4642
VL - 47
SP - 188
EP - 198
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 2
ER -