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Review
. 2021 Oct 1;27(5):468-473.
doi: 10.1097/MCC.0000000000000860.

Secondary pneumonias in critically ill patients with COVID-19: risk factors and outcomes

Pedro Povoa  1   2   3 , Ignacio Martin-Loeches  4   5 , Saad Nseir  6   7
Affiliations
Review

Secondary pneumonias in critically ill patients with COVID-19: risk factors and outcomes

Pedro Povoa et al. Curr Opin Crit Care. .

Abstract

Purpose of review: The aim of this review is to provide an overview of the current evidence of secondary pneumonias in COVID-19 patients, its incidence, risk factors and impact outcomes.

Recent findings: Early studies reported low incidence of hospital-acquired infections in COVID-19 patients. More recent large studies clearly showed that the incidence of secondary pneumonias was markedly high in patients under mechanical ventilation. Duration of mechanical ventilation, acute respiratory distress syndrome, prone position and male sex were identified as risk factors. The adjunctive therapy with steroids and immunomodulators were associated with a higher risk of pneumonia and invasive pulmonary Aspergillosis. Although secondary pneumonias seemed to be associated with poor outcomes, namely mortality, in comparison with influenza, no difference was found in heterogeneity of outcomes. Immunosuppressive therapy has been studied in several observational and randomized trials with conflicting results and the true impact on superinfections, namely secondary pneumonias, has not been properly assessed.

Summary: According to the current evidence, COVID-19 patients are at an increased risk of secondary pneumonias. The impact of immunosuppressive therapies on superinfections is yet to be determined. Further studies are needed to assess the true risk of secondary infections associated with immunosuppressive therapies and to identify preventive strategies.

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Conflict of interest statement

P.P., I.M.L. and S.N. have no conflicts of interest related to this topic.

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Risk factors of ventilator-associated pneumonia in COVID-19. ARDS, acute respiratory distress syndrome; MV, mechanical ventilation.
See this image and copyright information in PMC

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