ABSTRACT
SESSION TITLE: COVID-19: Other Considerations in Management SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: Patients who present with severe SARS CoV-2 2019 (COVID-19) infection frequently require invasive mechanical ventilation (MV) and subsequently are at increased risk of ventilator-associated pneumonia (VAP). We hypothesized that upfront empiric community acquired pneumonia (CAP) antimicrobial therapy is associated with reduced rates of VAP in patients with severe COVID-19 METHODS: After obtaining institutional review board approval, all patients admitted to the medical intensive care unit (ICU) at a tertiary care medical center with laboratory confirmed COVID-19 from March 2020- December 2020 were retrospectively identified. Exclusion criteria included outside hospital transfers, patients who underwent major surgery, were pregnant, < 18 years of age, and patients who did not require MV for at least 72 hours. Presence of VAP was defined as presence of positive sputum culture and worsening clinical and/or radiographic status requiring new antimicrobial treatment. Covid targeted therapies were defined as administration of either remdesivir, hydroxychloroquine, systemic steroids, or monoclonal antibodies. RESULTS: Overall, 113 patient’s met inclusion criteria with a median body mass index (BMI) of 32.9 kg/m2 (IQR 28.4-40.7) and age of 65 years (IQR 53-71). 65% (72/113) were male. High-dose corticosteroids were administered as part of institutional COVID-19 protocol in 44% (50/113). Median duration of MV was 16 days (IQR 11-24), 25% (28/113) of patients underwent tracheostomy, and 38% (43/113) expired during hospitalization. Empiric CAP antimicrobial therapy was started on hospital day 1 in 42% (47/113) of patients and primarily consisted of azithromycin in combination with ceftriaxone (97% [46/47]). On univariate analysis, duration of MV (p=0.003), absence of empiric antibiotic treatment of CAP (p=0.000), and male gender (p=0.045) were significantly associated with development of VAP. Neither medical comorbidities nor COVID-19 targeted therapy were associated with VAP. On multivariate logistic regression, lack of upfront empiric CAP antimicrobial therapy on admission was associated with development of VAP when adjusted for MV duration and gender (OR 0.23, 95% CI 0.09-0.54, p=0.001). CONCLUSIONS: Early empiric administration of CAP antimicrobial therapy in COVID-19 patients requiring MV was associated with reduced rates of VAP. CLINICAL IMPLICATIONS: Further prospective randomized studies are needed to better evaluate the potential risks and benefits of early empiric antibiotics to prevent hospital acquired infections in COVID-19 patients. DISCLOSURES: No relevant relationships by Robert Balk No relevant relationships by Rachel Geroux No relevant relationships by Seungjun Kim No relevant relationships by Christopher Seder No relevant relationships by Connor Wakefield