@article{3102854,
    title = "Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study",
    author = "Rouzé, A. and Martin-Loeches, I. and Povoa, P. and Makris, D. and Artigas, A. and Bouchereau, M. and Lambiotte, F. and Metzelard, M. and Cuchet, P. and Boulle Geronimi, C. and Labruyere, M. and Tamion, F. and Nyunga, M. and Luyt, C.-E. and Labreuche, J. and Pouly, O. and Bardin, J. and Saade, A. and Asfar, P. and Baudel, J.-L. and Beurton, A. and Garot, D. and Ioannidou, I. and Kreitmann, L. and Llitjos, J.-F. and Magira, E. and Mégarbane, B. and Meguerditchian, D. and Moglia, E. and Mekontso-Dessap, A. and Reignier, J. and Turpin, M. and Pierre, A. and Plantefeve, G. and Vinsonneau, C. and Floch, P.-E. and Weiss, N. and Ceccato, A. and Torres, A. and Duhamel, A. and Nseir, S. and Favory, R. and Preau, S. and Jourdain, M. and Poissy, J. and Bouras, C. and Saint Leger, P. and Fodil, H. and Aptel, F. and Van Der Linden, T. and Thille, A.W. and Azoulay, E. and Pène, F. and Razazi, K. and Bagate, F. and Contou, D. and Voiriot, G. and Thevenin, D. and Guidet, B. and Le Guennec, L. and Kouatchet, A. and Ehrmann, S. and Brunin, G. and Morawiec, E. and Boyer, A. and Argaud, L. and Voicu, S. and Nieszkowska, A. and Kowalski, B. and Goma, G. and Diaz, E. and Morales, L. and Tsolaki, V. and Gtavriilidis, G. and Mentzelopoulos, S.D. and Nora, D. and Boyd, S. and Coelho, L. and Maizel, J. and Du Cheyron, D. and Imouloudene, M. and Quenot, J.-P. and Guilbert, A. and Cilloniz, C. and on behalf of the coVAPid study Group",
    journal = "Intensive Care Medicine Experimental",
    year = "2021",
    volume = "47",
    number = "2",
    pages = "188-198",
    publisher = "Springer Science and Business Media Deutschland GmbH",
    issn = "2197-425X",
    doi = "10.1007/s00134-020-06323-9",
    keywords = "antibiotic agent;  corticosteroid;  dexamethasone;  hydrocortisone;  hydroxychloroquine;  interferon;  lopinavir plus ritonavir;  methylprednisolone;  oseltamivir;  remdesivir, adult;  aged;  antibiotic therapy;  antiviral therapy;  Article;  artificial ventilation;  clinical outcome;  cohort analysis;  colony forming unit;  controlled study;  coronavirus disease 2019;  Enterobacter;  extracorporeal oxygenation;  female;  Gram negative bacterium;  hospitalization;  human;  influenza;  invasive ventilation;  Klebsiella;  lower respiratory tract infection;  lung lavage;  major clinical study;  male;  multicenter study;  nonhuman;  observational study;  Pseudomonas aeruginosa;  retrospective study;  Sequential Organ Failure Assessment Score;  thorax radiography;  tracheobronchitis;  ventilator associated pneumonia;  virus pneumonia;  clinical trial;  Europe;  incidence;  influenza;  mechanical ventilator;  middle aged;  respiratory tract infection;  ventilator associated pneumonia, Aged;  COVID-19;  Europe;  Female;  Humans;  Incidence;  Influenza, Human;  Male;  Middle Aged;  Pneumonia, Ventilator-Associated;  Respiratory Tract Infections;  Retrospective Studies;  Ventilators, Mechanical",
    abstract = "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. © 2021, Springer-Verlag GmbH Germany, part of Springer Nature."
}