Tweet
Ann Intensive Care
. 2020 Nov 23;10(1):158.
doi: 10.1186/s13613-020-00775-4.
Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study
Charles-Edouard Luyt 1 2 , Tarek Sahnoun 3 , Melchior Gautier 3 , Pauline Vidal 4 , Sonia Burrel 5 6 , Marc Pineton de Chambrun 3 , Juliette Chommeloux 3 , Cyrielle Desnos 3 , Jeremy Arzoine 7 , Ania Nieszkowska 3 , Nicolas Br?chot 3 8 , Matthieu Schmidt 3 8 , Guillaume Hekimian 3 , David Boutolleau 5 6 , J?r?me Robert 4 , Alain Combes 3 8 , Jean Chastre 3 8
Affiliations
- PMID: 33230710
- DOI: 10.1186/s13613-020-00775-4
Abstract
Background: The data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited. We performed this retrospective cohort study to assess frequency, clinical characteristics, responsible pathogens, and outcomes of VAP in patients COVID-19 pneumonia requiring MV between March 12th and April 24th, 2020 (all had RT-PCR-confirmed SARS-CoV-2 infection). Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring ECMO were compared with an historical cohort of 45 patients with severe influenza-associated ARDS requiring ECMO admitted to the same ICU during the preceding three winter seasons.
Results: Among 50 consecutive patients with Covid-19-associated ARDS requiring ECMO included [median (IQR) age 48 (42-56) years; 72% male], 43 (86%) developed VAP [median (IQR) MV duration before the first episode, 10 (8-16) days]. VAP-causative pathogens were predominantly Enterobacteriaceae (70%), particularly inducible AmpC-cephalosporinase producers (40%), followed by Pseudomonas aeruginosa (37%). VAP recurred in 34 (79%) patients and 17 (34%) died. Most recurrences were relapses (i.e., infection with the same pathogen), with a high percentage occurring on adequate antimicrobial treatment. Estimated cumulative incidence of VAP, taking into account death and extubation as competing events, was significantly higher in Covid-19 patients than in influenza patients (p = 0.002). Despite a high P. aeruginosa-VAP rate in patients with influenza-associated ARDS (54%), the pulmonary infection recurrence rate was significantly lower than in Covid-19 patients. Overall mortality was similar for the two groups.
Conclusions: Patients with severe Covid-19-associated ARDS requiring ECMO had a very high late-onset VAP rate. Inducible AmpC-cephalosporinase-producing Enterobacteriaceae and Pseudomonas aeruginosa frequently caused VAP, with multiple recurrences and difficulties eradicating the pathogen from the lung.
Keywords: ARDS; Coronavirus; Covid-19; ECMO; Enterobacteriaceae; Ventilator-associated pneumonia.