Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study

• DOI: 10.1007/s00134-020-06323-9
• Publication Date: 2021-01-03T00:04:46Z
• Authors: Anahita Rouzé; Ignacio Martin-Lo...; Pedro Povoa; Demosthenes Makris; Antonio Artigas; Mathilde Bouchereau; Fabien Lambiotte; Matthieu Metzelard; Pierre Cuchet; Claire Boulle Ger...; Marie Labruyere; Fabienne Tamion; Martine Nyunga; Charles-Edouard Luyt; Julien Labreuche; Olivier Pouly; Justine Bardin; Anastasia Saade; Pierre Asfar; Jean-Luc Baudel; Alexandra Beurton; Denis Garot; Iliana Ioannidou; Louis Kreitmann; Jean-François Lli...; Eleni Magira; Bruno Mégarbane; David Meguerditchian; Edgar Moglia; Armand Mekontso-D...; Jean Reignier; Matthieu Turpin; Alexandre Pierre; Gaetan Plantefeve; Christophe Vinson...; Pierre-Edouard Floch; Nicolas Weiss; Adrian Ceccato; Antoni Torres; Alain Duhamel; Saad Nseir; ; Raphaël Favory; Sébastien Preau; Mercé Jourdain; Julien Poissy; Chaouki Bouras; Piehr Saint Leger; Hanane Fodil; François Aptel; Thierry Van Der L...; Arnaud W. Thille; Elie Azoulay; Frédéric Pène; Keyvan Razazi; François Bagate; Damien Contou; Guillaume Voiriot; Didier Thevenin; Bertrand Guidet; Loïc Le Guennec; Achille Kouatchet; Stephan Ehrmann; Guillaume Brunin; Elise Morawiec; Alexandre Boyer; Laurent Argaud; Sebastian Voicu; Ania Nieszkowska; Benjamin Kowalski; Gemma Goma; Emilio Diaz; Luis Morales; Vassiliki Tsolaki; George Gtavriilidis; Spyros D. Mentzel...; David Nora; Sean Boyd; Luis Coelho; Julien Maizel; Damien Du Cheyron; Mehdi Imouloudene; Jean-Pierre Quenot; Arnaud Guilbert; Catia Cilloniz
• Keywords: Male; Human/epidemiology; Original; [SDV]Life Sciences [q-bio]; Ventilators; 610; Respiratory Tract Infections/epidemiology; 03 medical and health sciences; 0302 clinical medicine; Influenza, Human/epidemiology; Pneumonia, Ventilator-Associated/epidemiology; 616; Influenza, Human; Ventilator-associated pneumonia; Humans; Respiratory Tract Infections; COVID-19/epidemiology; Aged; Retrospective Studies; Ventilators, Mechanical; SARS-CoV-2; Incidence; COVID-19; Pneumonia, Ventilator-Associated; Pneumonia; Middle Aged; Mechanical; Ventilator-associated tracheobronchitis; Influenza; 3. Good health; [SDV] Life Sciences [q-bio]; Europe; Ventilator-Associated/epidemiology; Female; Critical illness

Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI.Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models.1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp.The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates.