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Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study

2021; Springer Science+Business Media; Volume: 47; Issue: 2 Linguagem: Inglês

10.1007/s00134-020-06323-9

1432-1238

Anahita Rouzé, Ignacio Martín‐Loeches, Pedro Póvoa, Demosthènes Makris, Antonio Artigas, Mathilde Bouchereau, Fabien Lambiotte, Matthieu Metzelard, Pierre Cuchet, Claire Boulle Geronimi, Marie Labruyère, Fabienne Tamion, Martine Nyunga, Charles‐Édouard Luyt, Julien Labreuche, Olivier Pouly, Justine Bardin, Anastasia Saade, Pierre Asfar, Jean-Luc Baudel, Alexandra Beurton, Denis Garot, Iliana Ioannidou, Louis Kreitmann, Jean‐François Llitjos, Eleni Magira, Bruno Mégarbane, David Meguerditchian, Edgar Moglia, Armand Mekontso Dessap, Jean Reignier, Matthieu Turpin, Alexandre Pierre, Gaëtan Plantefève, Christophe Vinsonneau, Pierre-Edouard Floch, Nicolas Weiss, Adrián Ceccato, Antoní Torres, Alain Duhamel, Saad Nseir, Raphaël Favory, Sébastien Preau, M. Jourdain, Julien Poissy, Chaouki Bouras, Piehr Saint Leger, Hanane Fodil, François Aptel, Thierry Van Der Linden, Arnaud W. Thille, Élie Azoulay, Frédéric Pène, Keyvan Razazi, François Bagate, Damien Contou, Guillaume Voiriot, Didier Thévenin, Bertrand Guidet, Loïc Le Guennec, Achille Kouatchet, Stéphan Ehrmann, Guillaume Brunin, Élise Morawiec, Alexandre Boyer, Laurent Argaud, Sébastian Voicu, Ania Nieszkowska, Benjamin Kowalski, Gemma Gomà, Emilio Moyano‐Díaz, Luis Morales, Vasiliki Tsolaki, George Gtavriilidis, Spyros D. Mentzelopoulos, David Nora, Seán Boyd, Luís Coelho, Julien Maizel, Damien du Cheyron, Mehdi Imouloudene, Jean‐Pierre Quenot, Arnaud Guilbert, Catia Cillóniz,

Respiratory Support and Mechanisms

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.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.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.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.