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Multicenter Study
. 2024 Apr 20;28(1):131.
doi: 10.1186/s13054-024-04906-2.

Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis

Keyvan Razazi  1   2   3 , Charles-Edouard Luyt #  4 , Guillaume Voiriot #  5 , Anahita Rouzé #  6 , Marc Garnier  7 , Alexis Ferré  8 , Laurent Camous  9 , Nicholas Heming  10   11   12 , Nathanaël Lapidus  13 , Anais Charles-Nelson #  14 , Armand Mekontso-Dessap #  15   16   17 ; COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
Collaborators, Affiliations
Multicenter Study

Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis

Keyvan Razazi et al. Crit Care. .

Abstract

Background: Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring mechanical ventilation suffer from a high incidence of ventilator associated pneumonia (VAP), mainly related to Enterobacterales. Data regarding extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) VAP are scarce. We aimed to investigate risk factors and outcomes of ESBL-E related VAP among critically ill coronavirus infectious disease-19 (COVID-19) patients who developed Enterobacterales related VAP.

Patients and methods: We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included.

Results: We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19%), developed a first ESBL-E related VAP, mostly related to Enterobacter sp (n = 40), K. pneumoniae (n = 36), and E. coli (n = 31). Eight patients (1%) developed CRE related VAP. In a multivariable analysis, African origin (North Africa or Sub-Saharan Africa) (OR 1.7 [1.07-2.71], p = 0.02), time between intubation and VAP (OR 1.06 [1.02-1.09], p = 0.002), PaO2/FiO2 ratio on the day of VAP (OR 0.997 [0.994-0.999], p = 0.04) and trimethoprim-sulfamethoxazole exposure (OR 3.77 [1.15-12.4], p = 0.03) were associated with ESBL-E related VAP. Weaning from mechanical ventilation and mortality did not significantly differ between ESBL-E and non ESBL-E VAP.

Conclusion: ESBL-related VAP in COVID-19 critically-ill patients was not infrequent. Several risk factors were identified, among which some are modifiable and deserve further investigation. There was no impact of resistance of the first Enterobacterales related episode of VAP on outcome.

Keywords: ARDS; COVID-19; ESBL; Nosocomial pneumonia; Ventilator-associated pneumonia.

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Conflict of interest statement

CEL: AdvanzPharma and Merck for lecture. Grant from AdvanzPharma. Travel reimbursement for congress from Pfizer. AF reports honoraria by Fisher & Paykel for a lecture during SFMU Congress 2022, outside the submitted work MG reports personal fees as a speaker received from Medtronic outside the submitted work. AMD reports grants from Fischer Paykel, Baxter, Philips, Ferring and GSK, personal fees from Air Liquide, Baxter, Amomed, Getingue and Addmedica, outside the submitted work.

Figures

Fig. 1
Fig. 1
Flow chart of the study
Fig. 2
Fig. 2
Cumulative probability of weaning in ESBL-E related VAP (red) and non ESBL-E related VAP (black) patients. For analysis purpose, time from intubation to weaning (continuous line) to death (dotted line) were handled as competing risks
Fig. 3
Fig. 3
Ninety-day survival in patients with ESBL-E related VAP and non ESBL-E related VAP
See this image and copyright information in PMC

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