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Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19:
Luis Felipe Reyes1,2,3, Alejandro Rodriguez4, Yuli V Fuentes5,6
1Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia. luis.reyes5@unisabana.edu.co.
Insights
Ventilator-associated lower respiratory tract infections (VA-LRTI) are common in severe COVID-19 patients admitted to the ICU. Identifying risk factors for VA-LRTI is crucial for early diagnosis and improving patient outcomes, as these infections are linked to higher mortality.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Severe COVID-19 frequently leads to Intensive Care Unit (ICU) admission.
- Patients in the ICU with severe COVID-19 often develop ventilator-associated lower respiratory tract infections (VA-LRTI).
Purpose of the Study:
- To characterize clinical features of VA-LRTI in severe COVID-19 patients.
- To identify factors associated with VA-LRTI development.
- To assess the impact of VA-LRTI on clinical outcomes, including mortality.
Main Methods:
- Multicenter, observational cohort study across ten countries in Latin America and Europe.
- Inclusion of patients with confirmed SARS-CoV-2 requiring ICU admission and mechanical ventilation.
- Multivariate logistic regression and Random Forest analyses to determine risk factors and clinical impact.
Main Results:
- VA-LRTI occurred in 28.8% of 3287 severe COVID-19 patients.
- Ventilator-associated pneumonia (VAP) incidence was 18.6%, and ventilator-associated tracheobronchitis (VAT) was 10.3%.
- Prolonged mechanical ventilation, acute kidney injury (AKI), and comorbidities were risk factors for VA-LRTI. VAP increased hospital mortality risk (OR 1.81).
Conclusions:
- VA-LRTI, frequently caused by difficult-to-treat bacteria, is prevalent in severe COVID-19 ICU patients.
- VA-LRTI is associated with adverse clinical outcomes, including increased hospital mortality, particularly with VAP.
- Early identification of VA-LRTI risk factors can guide timely diagnosis and potentially improve patient outcomes.
Abstract:
Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
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