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Review
. 2022 Apr 1;35(2):170-175.
doi: 10.1097/QCO.0000000000000817.

How common is ventilator-associated pneumonia after coronavirus disease 2019?

Paul-Henri Wicky  1 , Camille d'Humières  2   3 , Jean-François Timsit  1   3
Affiliations
Review

How common is ventilator-associated pneumonia after coronavirus disease 2019?

Paul-Henri Wicky et al. Curr Opin Infect Dis. .

Abstract

Purpose of review: The first studies on COVID-19 patients with acute respiratory distress syndrome (ARDS) described a high rate of secondary bacterial ventilator-associated pneumonia (VAP). The specificity of VAP diagnoses in these patients are reviewed, including their actual rate.

Recent findings: Published studies described high rates of bacterial VAP among COVID-19 patients with ARDS, and these VAP episodes are usually severe and of specifically poor prognosis with high mortality. Indeed, Severe acute respiratory syndrome - coronavirus disease 19 (SARS-CoV2) infection elicits alterations that may explain a high risk of VAP. In addition, breaches in the aseptic management of patients might have occurred when the burden of care was heavy. In addition, VAP in these patients is more frequently suspected, and more often investigated with diagnostic tools based on molecular techniques.

Summary: VAP is frequented and of particularly poor prognosis in COVID-19 patients with ARDS. It can be explained by SARS-CoV-2 pathophysiology, and also breaches in the aseptic procedures. In addition, tools based on molecular techniques allow an early diagnosis and unmask VAP usually underdiagnosed by traditional culture-based methods. The impact of molecular technique-based diagnostics in improving antibacterial therapy and COVID-19 prognosis remain to be evaluated.

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Conflict of interest statement

J.F.T. is the principal investigator of the MULTICAP trial comparing a strategy with and without multiplex PCR for severe CAP (Projet Hospitalier de Recherche Clinique, French Ministry of Health, PHRC 16-0595, NCT03452826). Outside of the submitted work, J.F.T. reports lecture for MSD, Pfizer, Shionoghi, Thermofisher, advisory board in the past 5 years for Beckton-Dickinson, MSD, Pfizer, Gilead, Paratek, Nabriva, Medimune, Bayer Pharma and grant to his research unit from MSD, Pfizer, Thermofischer. P.H.W. and C.D. have no conflict of interest to declare.

Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
Ventilator-associated pneumonia in coronavirus disease 2019 patients with acute respiratory distress syndrome: potential pathophysiology, diagnostic and therapeutic strategies. ARDS, acute respiratory distress syndrome; CPE, carbapenemase producer enterobacterales; ESBLE extended Beta-lactamases producer enterobacterales; IL6 ra, IL-6 receptor antagonist; JAK, Janus kinase; MDRO, multidrug-resistant organisms; mPCR multiplex PCR; MRSA, methicillin-resistant Staphylococcus aureus; SARS-CoV2, Severe acute respiratory syndrome - coronavirus disease 19; VAP, ventilator-associated pneumonia; XDR GNB, extensively resistant Gram-negative bacteria.
See this image and copyright information in PMC

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