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 / Giacobbe, D. R.; Battaglini, D.; Enrile, E. M.; Dentone, C.; Vena, A.; Robba, C.; Ball, L.; Bartoletti, M.; Coloretti, I.; Di Bella, S.; Di Biagio, A.; Brunetti, I.; Mikulska, M.; Carannante, N.; De Maria, A.; Magnasco, L.; Maraolo, A. E.; Mirabella, M.; Montrucchio, G.; Patroniti, N.; Taramasso, L.; Tiseo, G.; Fornaro, G.; Fraganza, F.; Monastra, L.; Roman-Pognuz, E.; Paluzzano, G.; Fiorentino, G.; Corcione, A.; Bussini, L.; Pascale, R.; Corcione, S.; Tonetti, T.; Rinaldi, M.; Falcone, M.; Biagioni, E.; Ranieri, V. M.; Giannella, M.; De Rosa, F. G.; Girardis, M.; Menichetti, F.; Viale, P.; Pelosi, P.; Bassetti, M.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 10:4(2021), pp. 1-13. [10.3390/jcm10040555]

Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with covid-19: A multicenter study

Coloretti I.;Mirabella M.;Biagioni E.;Girardis M.;Menichetti F.;Pelosi P.;
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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Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with covid-19: A multicenter study / Giacobbe, D. R.; Battaglini, D.; Enrile, E. M.; Dentone, C.; Vena, A.; Robba, C.; Ball, L.; Bartoletti, M.; Coloretti, I.; Di Bella, S.; Di Biagio, A.; Brunetti, I.; Mikulska, M.; Carannante, N.; De Maria, A.; Magnasco, L.; Maraolo, A. E.; Mirabella, M.; Montrucchio, G.; Patroniti, N.; Taramasso, L.; Tiseo, G.; Fornaro, G.; Fraganza, F.; Monastra, L.; Roman-Pognuz, E.; Paluzzano, G.; Fiorentino, G.; Corcione, A.; Bussini, L.; Pascale, R.; Corcione, S.; Tonetti, T.; Rinaldi, M.; Falcone, M.; Biagioni, E.; Ranieri, V. M.; Giannella, M.; De Rosa, F. G.; Girardis, M.; Menichetti, F.; Viale, P.; Pelosi, P.; Bassetti, M.. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 10:4(2021), pp. 1-13. [10.3390/jcm10040555]
Giacobbe, D. R.; Battaglini, D.; Enrile, E. M.; Dentone, C.; Vena, A.; Robba, C.; Ball, L.; Bartoletti, M.; Coloretti, I.; Di Bella, S.; Di Biagio, A.; Brunetti, I.; Mikulska, M.; Carannante, N.; De Maria, A.; Magnasco, L.; Maraolo, A. E.; Mirabella, M.; Montrucchio, G.; Patroniti, N.; Taramasso, L.; Tiseo, G.; Fornaro, G.; Fraganza, F.; Monastra, L.; Roman-Pognuz, E.; Paluzzano, G.; Fiorentino, G.; Corcione, A.; Bussini, L.; Pascale, R.; Corcione, S.; Tonetti, T.; Rinaldi, M.; Falcone, M.; Biagioni, E.; Ranieri, V. M.; Giannella, M.; De Rosa, F. G.; Girardis, M.; Menichetti, F.; Viale, P.; Pelosi, P.; Bassetti, M.
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