Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study

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 inf...

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Detalles Bibliográficos
Autores: Rouze, A, Martin-Loeches, I, Povoa, P, Makris, D, Artigas, A, Bouchereau, M, Lambiotte, F, Metzelard, M, Cuchet, P, Geronimi, CB, Labruyere, M, Tamion, F, Nyunga, M, Luyt, CE, Labreuche, J, Pouly, O, Bardin, J, Saade, A, Asfar, P, Baudel, JL, Beurton, A, Garot, D, Ioannidou, I, Kreitmann, L, Llitjos, JF, Magira, E, Megarbane, B, Meguerditchian, D, Moglia, E, Mekontso-Dessap, A, Reignier, J, Turpin, M, Pierre, A, Plantefeve, G, Vinsonneau, C, Floch, PE, Weiss, N, Ceccato, A, Torres, A, Duhamel, A, Nseir, S
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p2120
Acceso en línea:https://i3pt.portalinvestigacion.com/publicaciones/2120
Access Level:acceso abierto
Palabra clave:SARS-CoV-2
COVID-19
Ventilator-associated pneumonia
Ventilator-associated tracheobronchitis
Critical illness
Descripción
Sumario: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.

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