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. 2021 May 7;10(5):545.
doi: 10.3390/antibiotics10050545.

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

Mariachiara Ippolito  1 , Giovanni Misseri  2 , Giulia Catalisano  1 , Claudia Marino  1 , Giulia Ingoglia  1 , Marta Alessi  1 , Elisa Consiglio  1 , Cesare Gregoretti  1   2 , Antonino Giarratano  1   3 , Andrea Cortegiani  1   3
Affiliations

Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis

Mariachiara Ippolito et al. Antibiotics (Basel). .

Abstract

The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of ventilator-associated pneumonia (VAP) among patients admitted to an intensive care unit with COVID-19 and mortality of those who developed VAP. We performed a systematic search on PubMed, EMBASE and Web of Science from inception to 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult patients with COVID-19 and reporting data on at least one primary outcome of interest. Random effect single-arm meta-analysis was performed for the occurrence of VAP and mortality (at the longest follow up) and ICU length of stay. Twenty studies were included in the systematic review and meta-analysis, for a total of 2611 patients with at least one episode of VAP. The pooled estimated occurrence of VAP was of 45.4% (95% C.I. 37.8-53.2%; 2611/5593 patients; I2 = 96%). The pooled estimated occurrence of mortality was 42.7% (95% C.I. 34-51.7%; 371/946 patients; I2 = 82%). The estimated summary estimated metric mean ICU LOS was 28.58 days (95% C.I. 21.4-35.8; I2 = 98%). Sensitivity analysis showed that patients with COVID-19 may have a higher risk of developing VAP than patients without COVID-19 (OR 3.24; 95% C.I. 2.2-4.7; P = 0.015; I2 = 67.7%; five studies with a comparison group).

Keywords: COVID-19; invasive mechanical ventilation; meta-analysis; ventilator-associated pneumonia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources.
Figure 2
Figure 2
Forest plot with the result of single-arm meta-analysis for the occurrence of VAP in patients with COVID-19. C.I., confidence interval; Ev, events; Trt, total.
Figure 3
Figure 3
Forest plot with the result of single-arm meta-analysis for mortality of patients with COVID-19 and VAP. C.I., confidence interval; Ev, events; Trt, total.
Figure 4
Figure 4
Forest plot with the results of the sensitivity analysis on the occurrence of ventilator-associated pneumonia in patients with COVID-19 compared to patients without COVID-19. C.I., confidence interval; Ctrl, controls; Ev, events; Trt, total.
See this image and copyright information in PMC

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