Prognostic Factors in COVID-19 Patients with Ventilator-Associated Pneumonia: A Single-Centre Experience

Coronavirus disease 2019 (COVID-19) presents with a broad range of symptoms, varying from mild or moderate illness to severe cases such as acute respiratory distress syndrome (ARDS) and death.  This study aimed to identify risk factors associated with the development of ventilator-associated pneumonia (VAP) and its impact on 14-day mortality in mechanically ventilated COVID-19 patients.

This study was conducted in our hospital's intensive care units (ICUs) between July 2020 and July 2021. It included patients aged 18 years and older who tested positive for SARS-CoV-2 by PCR. Demographic data, comorbidities, immunosuppressive treatments, antimicrobial therapies, and laboratory values were evaluated, along with pathogen identification and antimicrobial resistance rates.

A total of 311 patients were included in the study. The mean age was 72.6 ± 11.9 years. Hypertension (48.6%) was the most frequent comorbidity. Among patients who survived on day 14, higher rates of methylprednisolone (MP) use were observed (p=0.019), along with longer duration (p<0.001) and greater total dose (p<0.001). Pulse steroid therapy was more common in survivors (28%, p=0.007). Among patients who developed VAP, the duration and total dose of MP were higher (p<0.001 for both). Antibiotic therapy on day 14 showed macrolides (59.6%) and third-generation cephalosporins (36.5%) as the most frequently used. Acinetobacter baumannii was the most commonly isolated pathogen (62.5%), with 100% resistance to third-generation cephalosporins in Acinetobacter strains and 83.3% in Klebsiella pneumoniae. All strains of A. baumannii, K. pneumoniae, and Escherichia coli were resistant to carbapenems.

Fourteen-day survival was associated with higher corticosteroid use, including dexamethasone and MP, along with pulse steroid therapy. The use of immunosuppressive agents was more common in patients who developed VAP. Given the potential link between immunosuppressive therapy and VAP development, tailored treatment strategies should be considered for these patients.