tetano
Editor, Senior Moderator
Crit Care
. 2020 Dec 18;24(1):699.
doi: 10.1186/s13054-020-03417-0.
Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease
Keyvan Razazi[SUP] 1 2 [/SUP], Romain Arrestier[SUP] 3 4 [/SUP], Anne Fleur Haudebourg[SUP] 3 4 [/SUP], Brice Benelli[SUP] 3 4 [/SUP], Guillaume Carteaux[SUP] 3 4 5 [/SUP], Jean-Winoc Decousser[SUP] 6 7 8 [/SUP], Slim Fourati[SUP] 7 [/SUP], Paul Louis Woerther[SUP] 7 8 [/SUP], Frederic Schlemmer[SUP] 5 9 [/SUP], Anais Charles-Nelson[SUP] 10 [/SUP], Francoise Botterel[SUP] 7 8 [/SUP], Nicolas de Prost[SUP] 3 4 5 [/SUP], Armand Mekontso Dessap[SUP] 3 4 5 [/SUP]
Affiliations
Abstract
Background: Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited.
Methods: We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS).
Results: We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS: 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization.
Conclusions: In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.
Keywords: ARDS; COVID-19; Invasive aspergillosis; Nosocomial pneumonia; Ventilator-associated pneumonia.
. 2020 Dec 18;24(1):699.
doi: 10.1186/s13054-020-03417-0.
Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease
Keyvan Razazi[SUP] 1 2 [/SUP], Romain Arrestier[SUP] 3 4 [/SUP], Anne Fleur Haudebourg[SUP] 3 4 [/SUP], Brice Benelli[SUP] 3 4 [/SUP], Guillaume Carteaux[SUP] 3 4 5 [/SUP], Jean-Winoc Decousser[SUP] 6 7 8 [/SUP], Slim Fourati[SUP] 7 [/SUP], Paul Louis Woerther[SUP] 7 8 [/SUP], Frederic Schlemmer[SUP] 5 9 [/SUP], Anais Charles-Nelson[SUP] 10 [/SUP], Francoise Botterel[SUP] 7 8 [/SUP], Nicolas de Prost[SUP] 3 4 5 [/SUP], Armand Mekontso Dessap[SUP] 3 4 5 [/SUP]
Affiliations
- PMID: 33339526
- PMCID: PMC7747772
- DOI: 10.1186/s13054-020-03417-0
Abstract
Background: Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited.
Methods: We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS).
Results: We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS: 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization.
Conclusions: In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.
Keywords: ARDS; COVID-19; Invasive aspergillosis; Nosocomial pneumonia; Ventilator-associated pneumonia.