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 in...

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Detalles Bibliográficos
Autores principales: Rouzé, Anahita, Martin-Loeches, Ignacio, Povoa, Pedro, Makris, Demosthenes, Artigas, Antonio, Bouchereau, Mathilde, Lambiotte, Fabien, Metzelard, Matthieu, Cuchet, Pierre, Boulle Geronimi, Claire, Labruyere, Marie, Tamion, Fabienne, Nyunga, Martine, Luyt, Charles-Edouard, Labreuche, Julien, Pouly, Olivier, Bardin, Justine, Saade, Anastasia, Asfar, Pierre, Baudel, Jean-Luc, Beurton, Alexandra, Garot, Denis, Ioannidou, Iliana, Kreitmann, Louis, Llitjos, Jean-François, Magira, Eleni, Mégarbane, Bruno, Meguerditchian, David, Moglia, Edgar, Mekontso-Dessap, Armand, Reignier, Jean, Turpin, Matthieu, Pierre, Alexandre, Plantefeve, Gaetan, Vinsonneau, Christophe, Floch, Pierre-Edouard, Weiss, Nicolas, Ceccato, Adrian, Torres, Antoni, Duhamel, Alain, Nseir, Saad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Original
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778569/
https://www.ncbi.nlm.nih.gov/pubmed/33388794
http://dx.doi.org/10.1007/s00134-020-06323-9
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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06323-9) contains supplementary material, which is available to authorized users.

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