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Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia

Rationale: Current guidelines recommend patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia receive empirical antibiotics for suspected bacterial superinfection on the basis of weak evidence. Rates of ventilator-associated pneumonia (VAP) in clinical trials of patien...

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Autores principales: Pickens, Chiagozie O., Gao, Catherine A., Cuttica, Michael J., Smith, Sean B., Pesce, Lorenzo L., Grant, Rogan A., Kang, Mengjia, Morales-Nebreda, Luisa, Bavishi, Avni A., Arnold, Jason M., Pawlowski, Anna, Qi, Chao, Budinger, G. R. Scott, Singer, Benjamin D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Thoracic Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534629/
https://www.ncbi.nlm.nih.gov/pubmed/34409924
http://dx.doi.org/10.1164/rccm.202106-1354OC
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author Pickens, Chiagozie O.
Gao, Catherine A.
Cuttica, Michael J.
Smith, Sean B.
Pesce, Lorenzo L.
Grant, Rogan A.
Kang, Mengjia
Morales-Nebreda, Luisa
Bavishi, Avni A.
Arnold, Jason M.
Pawlowski, Anna
Qi, Chao
Budinger, G. R. Scott
Singer, Benjamin D.
author_facet Pickens, Chiagozie O.
Gao, Catherine A.
Cuttica, Michael J.
Smith, Sean B.
Pesce, Lorenzo L.
Grant, Rogan A.
Kang, Mengjia
Morales-Nebreda, Luisa
Bavishi, Avni A.
Arnold, Jason M.
Pawlowski, Anna
Qi, Chao
Budinger, G. R. Scott
Singer, Benjamin D.
author_sort Pickens, Chiagozie O.
collection PubMed
description Rationale: Current guidelines recommend patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia receive empirical antibiotics for suspected bacterial superinfection on the basis of weak evidence. Rates of ventilator-associated pneumonia (VAP) in clinical trials of patients with SARS-CoV-2 pneumonia are unexpectedly low. Objectives: We conducted an observational single-center study to determine the prevalence and etiology of bacterial superinfection at the time of initial intubation and the incidence and etiology of subsequent bacterial VAP in patients with severe SARS-CoV-2 pneumonia. Methods: Bronchoscopic BAL fluid samples from all patients with SARS-CoV-2 pneumonia requiring mechanical ventilation were analyzed using quantitative cultures and a multiplex PCR panel. Actual antibiotic use was compared with guideline-recommended therapy. Measurements and Main Results: We analyzed 386 BAL samples from 179 patients with SARS-CoV-2 pneumonia requiring mechanical ventilation. Bacterial superinfection within 48 hours of intubation was detected in 21% of patients. Seventy-two patients (44.4%) developed at least one VAP episode (VAP incidence rate = 45.2/1,000 ventilator days); 15 (20.8%) initial VAPs were caused by difficult-to-treat pathogens. The clinical criteria did not distinguish between patients with or without bacterial superinfection. BAL-based management was associated with significantly reduced antibiotic use compared with guideline recommendations. Conclusions: In patients with SARS-CoV-2 pneumonia requiring mechanical ventilation, bacterial superinfection at the time of intubation occurs in <25% of patients. Guideline-based empirical antibiotic management at the time of intubation results in antibiotic overuse. Bacterial VAP developed in 44% of patients and could not be accurately identified in the absence of microbiologic analysis of BAL fluid.
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spelling pubmed-85346292021-10-25 Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia Pickens, Chiagozie O. Gao, Catherine A. Cuttica, Michael J. Smith, Sean B. Pesce, Lorenzo L. Grant, Rogan A. Kang, Mengjia Morales-Nebreda, Luisa Bavishi, Avni A. Arnold, Jason M. Pawlowski, Anna Qi, Chao Budinger, G. R. Scott Singer, Benjamin D. Am J Respir Crit Care Med Original Articles Rationale: Current guidelines recommend patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia receive empirical antibiotics for suspected bacterial superinfection on the basis of weak evidence. Rates of ventilator-associated pneumonia (VAP) in clinical trials of patients with SARS-CoV-2 pneumonia are unexpectedly low. Objectives: We conducted an observational single-center study to determine the prevalence and etiology of bacterial superinfection at the time of initial intubation and the incidence and etiology of subsequent bacterial VAP in patients with severe SARS-CoV-2 pneumonia. Methods: Bronchoscopic BAL fluid samples from all patients with SARS-CoV-2 pneumonia requiring mechanical ventilation were analyzed using quantitative cultures and a multiplex PCR panel. Actual antibiotic use was compared with guideline-recommended therapy. Measurements and Main Results: We analyzed 386 BAL samples from 179 patients with SARS-CoV-2 pneumonia requiring mechanical ventilation. Bacterial superinfection within 48 hours of intubation was detected in 21% of patients. Seventy-two patients (44.4%) developed at least one VAP episode (VAP incidence rate = 45.2/1,000 ventilator days); 15 (20.8%) initial VAPs were caused by difficult-to-treat pathogens. The clinical criteria did not distinguish between patients with or without bacterial superinfection. BAL-based management was associated with significantly reduced antibiotic use compared with guideline recommendations. Conclusions: In patients with SARS-CoV-2 pneumonia requiring mechanical ventilation, bacterial superinfection at the time of intubation occurs in <25% of patients. Guideline-based empirical antibiotic management at the time of intubation results in antibiotic overuse. Bacterial VAP developed in 44% of patients and could not be accurately identified in the absence of microbiologic analysis of BAL fluid. American Thoracic Society 2021-03-30 /pmc/articles/PMC8534629/ /pubmed/34409924 http://dx.doi.org/10.1164/rccm.202106-1354OC Text en Copyright © 2021 by the American Thoracic Society https://creativecommons.org/licenses/by-nc-nd/4.0/This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . For commercial usage and reprints, please e-mail Diane Gern.
spellingShingle Original Articles
Pickens, Chiagozie O.
Gao, Catherine A.
Cuttica, Michael J.
Smith, Sean B.
Pesce, Lorenzo L.
Grant, Rogan A.
Kang, Mengjia
Morales-Nebreda, Luisa
Bavishi, Avni A.
Arnold, Jason M.
Pawlowski, Anna
Qi, Chao
Budinger, G. R. Scott
Singer, Benjamin D.
Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
title Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
title_full Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
title_fullStr Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
title_full_unstemmed Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
title_short Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
title_sort bacterial superinfection pneumonia in patients mechanically ventilated for covid-19 pneumonia
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534629/
https://www.ncbi.nlm.nih.gov/pubmed/34409924
http://dx.doi.org/10.1164/rccm.202106-1354OC
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