Ventilator-associated pneumonia in critically ill patients with COVID-19

Background Pandemic COVID-19 caused by the coronavirus SARS-CoV-2 has a high incidence of patients with severe acute respiratory syndrome (SARS). Many of these patients require admission to an intensive care unit (ICU) for invasive ventilation and are at significant risk of developing a secondary, v...

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Published in:Critical care (London, England) Vol. 25; no. 1; pp. 25 - 11
Main Authors: Maes, Mailis, Higginson, Ellen, Pereira-Dias, Joana, Curran, Martin D., Parmar, Surendra, Khokhar, Fahad, Cuchet-Lourenço, Delphine, Lux, Janine, Sharma-Hajela, Sapna, Ravenhill, Benjamin, Hamed, Islam, Heales, Laura, Mahroof, Razeen, Soderholm, Amelia, Forrest, Sally, Sridhar, Sushmita, Brown, Nicholas M., Baker, Stephen, Navapurkar, Vilas, Dougan, Gordon, Bartholdson Scott, Josefin, Conway Morris, Andrew
Format: Journal Article
Language:English
Published: London BioMed Central 11.01.2021
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Aged
Anesthesia
Aspergillosis
Coronaviruses
COVID-19
COVID-19 - diagnosis
COVID-19 - epidemiology
COVID-19 - therapy
Critical care
Critical Care Medicine
Critical Illness - epidemiology
Critical Illness - therapy
Critically ill
Emergency Medicine
Female
Humans
Intensive
Intensive care
Intensive Care Units - trends
Investigations
Lavage
Male
Medical diagnosis
Medicine
Medicine & Public Health
Microbiology
Middle Aged
Molecular diagnostics
Nosocomial infections
Pathogens
Pneumonia
Pneumonia, Ventilator-Associated - diagnosis
Pneumonia, Ventilator-Associated - epidemiology
Retrospective Studies
Risk factors
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Statistics
Survival analysis
Ventilator-associated pneumonia
Ventilators
United Kingdom
United Kingdom > UK
COVID-19
Critical care
SARS-CoV-2
Molecular diagnostics
Ventilator-associated pneumonia
Nosocomial infections
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Summary:Background Pandemic COVID-19 caused by the coronavirus SARS-CoV-2 has a high incidence of patients with severe acute respiratory syndrome (SARS). Many of these patients require admission to an intensive care unit (ICU) for invasive ventilation and are at significant risk of developing a secondary, ventilator-associated pneumonia (VAP). Objectives To study the incidence of VAP and bacterial lung microbiome composition of ventilated COVID-19 and non-COVID-19 patients. Methods In this retrospective observational study, we compared the incidence of VAP and secondary infections using a combination of microbial culture and a TaqMan multi-pathogen array. In addition, we determined the lung microbiome composition using 16S RNA analysis in a subset of samples. The study involved 81 COVID-19 and 144 non-COVID-19 patients receiving invasive ventilation in a single University teaching hospital between March 15th 2020 and August 30th 2020. Results COVID-19 patients were significantly more likely to develop VAP than patients without COVID (Cox proportional hazard ratio 2.01 95% CI 1.14–3.54, p  = 0.0015) with an incidence density of 28/1000 ventilator days versus 13/1000 for patients without COVID ( p  = 0.009). Although the distribution of organisms causing VAP was similar between the two groups, and the pulmonary microbiome was similar, we identified 3 cases of invasive aspergillosis amongst the patients with COVID-19 but none in the non-COVID-19 cohort. Herpesvirade activation was also numerically more frequent amongst patients with COVID-19. Conclusion COVID-19 is associated with an increased risk of VAP, which is not fully explained by the prolonged duration of ventilation. The pulmonary dysbiosis caused by COVID-19, and the causative organisms of secondary pneumonia observed are similar to that seen in critically ill patients ventilated for other reasons.
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-021-03460-5