Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 4;12(2):421.
doi: 10.3390/jcm12020421.

Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France

Jacques Moreno  1 , Julien Carvelli  1   2 , Audrey Lesaux  1 , Mohamed Boucekine  3   4 , David Tonon  5 , Amandine Bichon  1 , Marc Gainnier  1   6 , Jeremy Bourenne  1   6
Affiliations

Ventilator Acquired Pneumonia in COVID-19 ICU Patients: A Retrospective Cohort Study during Pandemia in France

Jacques Moreno et al. J Clin Med. .

Abstract

Describe the characteristics of ventilation-acquired pneumonia (VAP) and potential risk factors in critically ill SARS-CoV-2 patients admitted in three French public hospitals during the first year of the COVID-19 pandemic. We conducted a monocentric retrospective study in seven Marseille intensive care units (ICUs) aiming to describe VAP characteristics and identify their risk factors. VAP patients were compared to a non-VAP control group. From March to November 2020, 161 patients admitted for viral-induced acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV) were included. This cohort was categorized in two groups according to the development or not of a VAP during their stay in ICU. 82 patients (51%) developed ventilation-acquired pneumonia. Most of them were men (77%) and 55% had hypertension. In the VAP population, 31 out of 82 patients (38%) had received dexamethasone and 47% were administered antibiotic course prior to ICU admission. An amount of 88% of respiratory infections were late VAPs with a median delay of 10 days from the onset of IMV. Gram negative bacteria were responsible for 62% of VAPs with Pseudomonas spp. being the most documented bacteria. Less than a third of the ICU-acquired infections were due to multidrug resistant (MDR) bacteria mainly displaying AmpC cephalosporin hyper production resistance phenotype. Multivariate analysis revealed that early Dexamethasone administration in ICU, male sex, older age and ROX score were risk factors for VAP whereas pre-ICU antimicrobial treatment and higher IGS 2 were protective factors. VAP is a frequent ICU-related complication affecting half of patients infected with SARS-CoV-2 and requiring IMV. It was responsible for increased morbidity due to a longer ICU and hospital stay. VAP risk factors included demographic factors such as age and sex. Dexamethasone was associated with a threefold greater risk of developing VAP during ICU stay. These results need to be comforted by large multi-centric studies before questioning the only available and effective treatment against SARS-CoV-2 in ICU patients.

Keywords: SARS-CoV-2 pneumonia; acute respiratory failure; early antibio-therapy; infectious risk factors; ventilor acquired pneumonia.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study Flow chart.
Figure 2
Figure 2
Ventilation-acquired pneumonia bacterial documentation.
Figure 3
Figure 3
Antibiotic resistance mechanisms according to type of infection and bacteria.
Figure 3
Figure 3
Antibiotic resistance mechanisms according to type of infection and bacteria.
See this image and copyright information in PMC

References

    1. COVID-19 Map Johns Hopkins Coronavirus Resource Center. [(accessed on 30 July 2022)]. Available online: https://coronavirus.jhu.edu/map.html.
    1. Fiolet T., Kherabi Y., MacDonald C.J., Ghosn J., Peiffer-Smadja N. Comparing COVID-19 vaccines for their characteristics, efficacy and effectiveness against SARS-CoV-2 and variants of concern: A narrative review. Clin. Microbiol. Infect. 2022;28:202–221. doi: 10.1016/j.cmi.2021.10.005. - DOI - PMC - PubMed
    1. Tregoning J.S., Flight K.E., Higham S.L., Wang Z., Pierce B.F. Progress of the COVID-19 vaccine effort: Viruses, vaccines and variants versus efficacy, effectiveness and escape. Nat. Rev. Immunol. 2021;21:626–636. doi: 10.1038/s41577-021-00592-1. - DOI - PMC - PubMed
    1. European Centre for Disease Prevention and Control SARS-CoV-2 Variants of Concern as of 28 July 2022. [(accessed on 30 July 2022)]. Available online: https://www.ecdc.europa.eu/en/covid-19/variants-concern.
    1. Tracking SARS-CoV-2 Variants. [(accessed on 30 July 2022)]. Available online: https://www.who.int/activities/tracking-SARS-CoV-2-variants.

LinkOut - more resources