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. 2022 Feb 1;28(1):74-82.
doi: 10.1097/MCC.0000000000000908.

Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients

Jacopo Fumagalli  1 , Mauro Panigada  1 , Michael Klompas  2   3 , Lorenzo Berra  4
Affiliations

Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients

Jacopo Fumagalli et al. Curr Opin Crit Care. .

Abstract

Purpose of review: We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS).

Recent findings: Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (<15%) but a high proportion of patients developed positive bacterial cultures thereafter leading to a VAP diagnosis (range 21-64%, weighted average 50%). Diagnostic criteria varied between studies but most signs of VAP have substantial overlap with the signs of C-ARDS making it difficult to differentiate between bacterial colonization versus superinfection. Most episodes of VAP were associated with Gram-negative bacteria. Occasional cases were also attributed to herpes virus reactivations and pulmonary aspergillosis. Potential factors driving high VAP incidence rates include immunoparalysis, prolonged ventilation, exposure to immunosuppressants, understaffing, lapses in prevention processes, and overdiagnosis.

Summary: Covid-19 patients who require mechanical ventilation for ARDS have a high risk (>50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
Risk factors for developing ventilator-associated pneumonia among covid-related acute respiratory distress syndrome patients. The disease, treatment, and pandemic logistics-related risk factors, which may have contributed, independently or synergistically, to the high rate of VAP observed among mechanically ventilated C-ARDS patients are illustrated. ARDS, acute respiratory distress syndrome; MV, mechanical ventilation; PPE, personal protective equipment; VAP, ventilator-associated pneumonia.
See this image and copyright information in PMC

References

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