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. 2021 Feb 3;10(4):555.
doi: 10.3390/jcm10040555.

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

Daniele Roberto Giacobbe  1 , Denise Battaglini  2 , Elisa Martina Enrile  2   3 , Chiara Dentone  1 , Antonio Vena  1 , Chiara Robba  2   3 , Lorenzo Ball  2   3 , Michele Bartoletti  4 , Irene Coloretti  5 , Stefano Di Bella  6 , Antonio Di Biagio  1   7 , Iole Brunetti  2 , Malgorzata Mikulska  1   7 , Novella Carannante  8 , Andrea De Maria  1   7 , Laura Magnasco  1   7 , Alberto Enrico Maraolo  9 , Michele Mirabella  1   7 , Giorgia Montrucchio  10   11 , Nicolò Patroniti  2   3 , Lucia Taramasso  1 , Giusy Tiseo  12 , Giacomo Fornaro  4 , Fiorentino Fraganza  13 , Luca Monastra  13 , Erik Roman-Pognuz  6   14 , Giacomo Paluzzano  6 , Giuseppe Fiorentino  15 , Antonio Corcione  16 , Linda Bussini  4 , Renato Pascale  4 , Silvia Corcione  17 , Tommaso Tonetti  18 , Matteo Rinaldi  4 , Marco Falcone  12 , Emanuela Biagioni  5 , Vito Marco Ranieri  18 , Maddalena Giannella  4 , Francesco Giuseppe De Rosa  17 , Massimo Girardis  5 , Francesco Menichetti  12 , Pierluigi Viale  4 , Paolo Pelosi  2   3 , Matteo Bassetti  1   7
Affiliations

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

Daniele Roberto Giacobbe et al. J Clin Med. .

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.

Keywords: COVID-19; SARS-CoV-2; VAP; coronavirus; ventilation.

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Conflict of interest statement

Outside the submitted work, M.B. (Matteo Bassetti) has participated in advisory boards and/or received speaker honoraria from Achaogen, Angelini, Astellas, Bayer, Basilea, BioMérieux, Cidara, Gilead, Menarini, MSD, Nabriva, Paratek, Pfizer, Roche, Melinta, Shionogi, Tetraphase, VenatoRx and Vifor and has received study grants from Angelini, Basilea, Astellas, Shionogi, Cidara, Melinta, Gilead, Pfizer and MSD. Outside the submitted work, D.R.G. reports honoraria from Stepstone Pharma GmbH and an unconditional grant from MSD Italia. The other authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Survival in critically ill COVID-19 patients with VAP. Comparison of survival in patients who did not underwent bronchoscopy and patients with positive culture of bronchoalveolar lavage fluid (BALF) at ventilator-associated pneumonia (VAP) onset. The time of origin was set at the day of VAP onset. p-value is from log-rank test. Two patients with negative BALF cultures were excluded from this analysis.
See this image and copyright information in PMC

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