by Keyvan Razazi, Romain Arrestier, Anne Fleur Haudebourg,
Brice Benelli, Guillaume Carteaux, Jean‑Winoc Decousser, Slim Fourati, Paul
Louis Woerther, Frederic Schlemmer, Anais Charles-Nelson, Francoise Botterel,
Nicolas de Prost and Armand Mekontso Dessap
Critical Care volume 24,
Article number: 699 (2020) Published: 18
December 2020
Background
Data on incidence of ventilator-associated pneumonia (VAP)
and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2
infection are limited.
Methods
We conducted a monocenter retrospective study comparing the
incidence of VAP and invasive aspergillosis between patients with
COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with
non-SARS-CoV-2 viral ARDS (NC-ARDS).
Results
We assessed 90 C-ARDS and 82 NC-ARDS patients, who were
mechanically ventilated for more than 48 h. At ICU admission, there were
significantly fewer bacterial coinfections documented in C-ARDS than in
NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more
patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS:
58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly
higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard
ratio = 1.72 (1.14–2.52), p < 0.01]. The incidence of
multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in
C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was
more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01.
According to AspICU algorithm, there were fewer cases of putative aspergillosis
in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was
no difference in Aspergillus colonization.
Conclusions
In our experience, we evidenced a higher incidence of VAP
and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive
aspergillosis in the former group.
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