Περίληψη:
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.
Συγγραφείς:
Rouzé, A.
Martin-Loeches, I.
Povoa, P.
Makris, D.
Artigas, A.
Bouchereau, M.
Lambiotte, F.
Metzelard, M.
Cuchet, P.
Boulle Geronimi, C.
Labruyere, M.
Tamion, F.
Nyunga, M.
Luyt, C.-E.
Labreuche, J.
Pouly, O.
Bardin, J.
Saade, A.
Asfar, P.
Baudel, J.-L.
Beurton, A.
Garot, D.
Ioannidou, I.
Kreitmann, L.
Llitjos, J.-F.
Magira, E.
Mégarbane, B.
Meguerditchian, D.
Moglia, E.
Mekontso-Dessap, A.
Reignier, J.
Turpin, M.
Pierre, A.
Plantefeve, G.
Vinsonneau, C.
Floch, P.-E.
Weiss, N.
Ceccato, A.
Torres, A.
Duhamel, A.
Nseir, S.
Favory, R.
Preau, S.
Jourdain, M.
Poissy, J.
Bouras, C.
Saint Leger, P.
Fodil, H.
Aptel, F.
Van Der Linden, T.
Thille, A.W.
Azoulay, E.
Pène, F.
Razazi, K.
Bagate, F.
Contou, D.
Voiriot, G.
Thevenin, D.
Guidet, B.
Le Guennec, L.
Kouatchet, A.
Ehrmann, S.
Brunin, G.
Morawiec, E.
Boyer, A.
Argaud, L.
Voicu, S.
Nieszkowska, A.
Kowalski, B.
Goma, G.
Diaz, E.
Morales, L.
Tsolaki, V.
Gtavriilidis, G.
Mentzelopoulos, S.D.
Nora, D.
Boyd, S.
Coelho, L.
Maizel, J.
Du Cheyron, D.
Imouloudene, M.
Quenot, J.-P.
Guilbert, A.
Cilloniz, C.
on behalf of the coVAPid study Group
