The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16-21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were Pseudomonas aeruginosa (27/77, 35%) and Staphylococcus aureus (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43-7.61, p = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05-57.26, p < 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases.

Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study

Montrucchio, Giorgia;Corcione, Silvia;Ranieri, Vito Marco;De Rosa, Francesco Giuseppe;
2021

Abstract

The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16-21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were Pseudomonas aeruginosa (27/77, 35%) and Staphylococcus aureus (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43-7.61, p = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05-57.26, p < 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases.
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COVID-19; SARS-CoV-2; VAP; coronavirus; ventilation
Giacobbe, Daniele Roberto; Battaglini, Denise; Enrile, Elisa Martina; Dentone, Chiara; Vena, Antonio; Robba, Chiara; Ball, Lorenzo; Bartoletti, Michele; Coloretti, Irene; Di Bella, Stefano; Di Biagio, Antonio; Brunetti, Iole; Mikulska, Malgorzata; Carannante, Novella; De Maria, Andrea; Magnasco, Laura; Maraolo, Alberto Enrico; Mirabella, Michele; Montrucchio, Giorgia; Patroniti, Nicolò; Taramasso, Lucia; Tiseo, Giusy; Fornaro, Giacomo; Fraganza, Fiorentino; Monastra, Luca; Roman-Pognuz, Erik; Paluzzano, Giacomo; Fiorentino, Giuseppe; Corcione, Antonio; Bussini, Linda; Pascale, Renato; Corcione, Silvia; Tonetti, Tommaso; Rinaldi, Matteo; Falcone, Marco; Biagioni, Emanuela; Ranieri, Vito Marco; Giannella, Maddalena; De Rosa, Francesco Giuseppe; Girardis, Massimo; Menichetti, Francesco; Viale, Pierluigi; Pelosi, Paolo; Bassetti, Matteo
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1785578
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