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Published on: September 24, 2020
Pneumonia Characteristics in an Intensive Care Unit Setting during and after the COVID-19 Pandemic-A Single-Center
Jakub Sleziak1, Katarzyna Pilarczyk1, Michal Matysiak1
1The Students Scientific Association by Department and Clinic of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, L. Pasteura Street 1, 50-367 Wroclaw, Poland.
Insights
Pneumonia rates, including community-acquired (CAP) and hospital-acquired (HAP), were significantly higher during the COVID-19 pandemic than post-pandemic. SARS-CoV-2 was the primary CAP pathogen, associated with high mortality.
Area of Science:
- Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- The COVID-19 pandemic raised concerns about changing rates of respiratory tract infections (RTIs), especially pneumonia (PN).
- Understanding pneumonia epidemiology during and after the pandemic is crucial for patient care and public health.
- This study investigates trends in community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP).
Purpose of the Study:
- To evaluate epidemiological indicators of CAP and HAP during and after the COVID-19 pandemic.
- To identify key pathogens, risk factors, and mortality associated with different types of pneumonia.
- To compare pneumonia incidence rates between pandemic and post-pandemic periods.
Main Methods:
- Retrospective analysis of 1740 patients over 22,774 patient-days and 18,039 ventilation days.
- Categorization of pneumonia cases into CAP, ventilator-associated pneumonia (VAP), and non-ventilator HAP (NV-HAP).
- Identification of causative pathogens and assessment of mortality rates.
Main Results:
- Pneumonia affected 39.14% of ICU patients, with CAP (19.31%) and HAP (19.83%) being common.
- CAP incidence per 1000 patient-days was over three times higher during the pandemic (20.25) versus post-pandemic (5.86).
- SARS-CoV-2 was the dominant CAP pathogen (80.4%), linked to a 61.87% mortality rate; Acinetobacter baumannii was common in HAP.
Conclusions:
- Pneumonia remains a significant complication in ICU patients, particularly during pandemics.
- Surveillance of pneumonia during the COVID-19 pandemic provided valuable epidemiological and microbiological insights.
- Targeted interventions are needed to manage pneumonia, especially VAP and CAP caused by specific pathogens like SARS-CoV-2.
Abstract:
Background: During and after the COVID-19 pandemic, there was a suspicion of varying rates of respiratory tract infections (RTIs), particularly pneumonia (PN). Methods: This research evaluated epidemiological indicators of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) in the COVID-19 pandemic and post-pandemic period, including pathogens, ventilator-associated pneumonia (VAP), selected risk factors, and PN mortality. Results: At 1740 patients, throughout the 22,774 patient-days (Pt-D) and 18,039 ventilation days (Vt-D), there were 681 PN cases (39.14%): CAP 336 (19.31%) and HAP 345 (19.83%). CAP caused by SARS-CoV-2 was diagnosed in 257/336 (76.49%) patients. The clinical manifestations of PNs were CAP with 336/681 (49.34%), VAP with 232/681 (34.07%), and non-ventilator HAP (NV-HAP) with 113/681 cases (16.59%). The incidence rate of CAP/1000 Pt-D has been over 3 times higher in the pandemic period of 2020-2021 (20.25) than in the post-pandemic period of 2022 (5.86), p = 0.000. Similarly, higher incidence rates of VAP/1000 Pt-D were found in the pandemic period (p = 0.050). For NV-HAP, this difference was not statistically significant (p = 0.585). VAP occurred more frequently in the group of patients with PN in the course of COVID-19 compared to patients without COVID-19 (52/234 [22.2%] vs. 180/1506 [11.95%]); (p = 0.000). The most common CAP pathogen (during the pandemic) was SARS CoV-2 234/291 (80.4%), followed by MSSA/MRSA 8/291 (2.75%), whereas the most common VAP/NV-HAP pathogen was Acinetobacter baumannii XDR/MDR. The highest PN mortality was found in the patients with CAP caused by SARS-CoV-2 159/257 (61.87%). Conclusions: Pneumonias were diagnosed in nearly 40% of Intensive Care Unit (ICU) patients. Surveillance of pneumonias during the specific observation period was beneficial in the epidemiological and microbiological analysis of the ICU patients.
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