TY - JOUR
TI - Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study
AU - Rouzé, A.
AU - Martin-Loeches, I.
AU - Povoa, P.
AU - Makris, D.
AU - Artigas, A.
AU - Bouchereau, M.
AU - Lambiotte, F.
AU - Metzelard, M.
AU - Cuchet, P.
AU - Boulle Geronimi, C.
AU - Labruyere, M.
AU - Tamion, F.
AU - Nyunga, M.
AU - Luyt, C.-E.
AU - Labreuche, J.
AU - Pouly, O.
AU - Bardin, J.
AU - Saade, A.
AU - Asfar, P.
AU - Baudel, J.-L.
AU - Beurton, A.
AU - Garot, D.
AU - Ioannidou, I.
AU - Kreitmann, L.
AU - Llitjos, J.-F.
AU - Magira, E.
AU - Mégarbane, B.
AU - Meguerditchian, D.
AU - Moglia, E.
AU - Mekontso-Dessap, A.
AU - Reignier, J.
AU - Turpin, M.
AU - Pierre, A.
AU - Plantefeve, G.
AU - Vinsonneau, C.
AU - Floch, P.-E.
AU - Weiss, N.
AU - Ceccato, A.
AU - Torres, A.
AU - Duhamel, A.
AU - Nseir, S.
AU - Favory, R.
AU - Preau, S.
AU - Jourdain, M.
AU - Poissy, J.
AU - Bouras, C.
AU - Saint Leger, P.
AU - Fodil, H.
AU - Aptel, F.
AU - Van Der Linden, T.
AU - Thille, A.W.
AU - Azoulay, E.
AU - Pène, F.
AU - Razazi, K.
AU - Bagate, F.
AU - Contou, D.
AU - Voiriot, G.
AU - Thevenin, D.
AU - Guidet, B.
AU - Le Guennec, L.
AU - Kouatchet, A.
AU - Ehrmann, S.
AU - Brunin, G.
AU - Morawiec, E.
AU - Boyer, A.
AU - Argaud, L.
AU - Voicu, S.
AU - Nieszkowska, A.
AU - Kowalski, B.
AU - Goma, G.
AU - Diaz, E.
AU - Morales, L.
AU - Tsolaki, V.
AU - Gtavriilidis, G.
AU - Mentzelopoulos, S.D.
AU - Nora, D.
AU - Boyd, S.
AU - Coelho, L.
AU - Maizel, J.
AU - Du Cheyron, D.
AU - Imouloudene, M.
AU - Quenot, J.-P.
AU - Guilbert, A.
AU - Cilloniz, C.
AU - on behalf of the coVAPid study Group
JO - Intensive Care Medicine Experimental
PY - 2021
VL - 47
TODO - 2
SP - 188-198
PB - Springer Science and Business Media Deutschland GmbH
SN - 2197-425X
TODO - 10.1007/s00134-020-06323-9
TODO - 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
TODO - 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.
ER -