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Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study.
Rouzé, Anahita; Martin-Loeches, Ignacio; Povoa, Pedro; Makris, Demosthenes; Artigas, Antonio; Bouchereau, Mathilde; Lambiotte, Fabien; Metzelard, Matthieu; Cuchet, Pierre; Boulle Geronimi, Claire; Labruyere, Marie; Tamion, Fabienne; Nyunga, Martine; Luyt, Charles-Edouard; Labreuche, Julien; Pouly, Olivier; Bardin, Justine; Saade, Anastasia; Asfar, Pierre; Baudel, Jean-Luc; Beurton, Alexandra; Garot, Denis; Ioannidou, Iliana; Kreitmann, Louis; Llitjos, Jean-François; Magira, Eleni; Mégarbane, Bruno; Meguerditchian, David; Moglia, Edgar; Mekontso-Dessap, Armand; Reignier, Jean; Turpin, Matthieu; Pierre, Alexandre; Plantefeve, Gaetan; Vinsonneau, Christophe; Floch, Pierre-Edouard; Weiss, Nicolas; Ceccato, Adrian; Torres, Antoni; Duhamel, Alain; Nseir, Saad.
  • Rouzé A; CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France.
  • Martin-Loeches I; Université de Lille, INSERM U995, Team Fungal Associated Invasive and Inflammatory Diseases, Lille Inflammation Research International Center, Lille, France.
  • Povoa P; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St. James Street, Dublin 8, Dublin, Eire, Ireland.
  • Makris D; Hospital Clinic, IDIBAPS, Universided de Barcelona, CIBERes, Barcelona, Spain.
  • Artigas A; Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, and NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.
  • Bouchereau M; Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark.
  • Lambiotte F; Intensive Care Unit, University Hospital of Larissa, University of Thessaly, Biopolis Larissa, 41110, Vólos, Greece.
  • Metzelard M; Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Parc Tauli 1, 08028, Sabadell, Spain.
  • Cuchet P; CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France.
  • Boulle Geronimi C; Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France.
  • Labruyere M; Medical ICU, Amiens University Hospital, Amiens, France.
  • Tamion F; Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France.
  • Nyunga M; Service de Réanimation et de Soins Intensifs, Centre Hospitalier de Douai, Route de Cambrai, Douai, France.
  • Luyt CE; Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.
  • Labreuche J; Medical Intensive Care Unit, Rouen University Hospital, Normandie Université, UNIROUEN, Inserm U1096, FHU-REMOD-VHF, 76000, Rouen, France.
  • Pouly O; ICU, Roubaix Hospital, Roubaix, France.
  • Bardin J; Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
  • Saade A; Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de santé et des Pratiques Médicales, 59000, Lille, France.
  • Asfar P; Médecine Intensive Réanimation, Hôpital Saint Philibert GHICL, Université Catholique, Lille, France.
  • Baudel JL; CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France.
  • Beurton A; Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France.
  • Garot D; Département de Médecine Intensive-Réanimation, CHU d'Angers, Université d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
  • Ioannidou I; Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571, Cedex 12, France.
  • Kreitmann L; Service de Pneumologie, Médecine Intensive, Réanimation (Département "R3S"), AP-HP, Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière Charles Foix, 75013, Paris, France.
  • Llitjos JF; Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 2 Bd Tonnellé, 37000, Tours, France.
  • Magira E; 1st Department of Pulmonary Medicine and Intensive Care Unit, "Sotiria" Chest Hospital, National and Kapodistrian University of Athens, Athens, Greece.
  • Mégarbane B; Service de Médecine Intensive, Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69437, Lyon Cedex 03, France.
  • Meguerditchian D; Medical Intensive Care Unit, Cochin Hospital, AP-HP, Centre, Université de Paris, Paris, France.
  • Moglia E; 1st Department of Intensive Care Medicine, Evaggelismos Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
  • Mekontso-Dessap A; Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Université de Paris, INSERM UMRS-1144, Paris, France.
  • Reignier J; Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France.
  • Turpin M; Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain.
  • Pierre A; Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de réanimation médicale, Créteil, France.
  • Plantefeve G; Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France.
  • Vinsonneau C; Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France.
  • Floch PE; Réanimation polyvalente, CH Lens, Lens, France.
  • Weiss N; Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France.
  • Ceccato A; Intensive Care Unit, Hôpital de Béthune, 62408, Béthune, France.
  • Torres A; Service de Réanimation, Hôpital Duchenne, Rue Monod, 62200, Boulogne-sur-Mer, France.
  • Duhamel A; Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Paris, France.
  • Nseir S; Intensive Care Unit, Hospital Universitari Sagrat Cor, and Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028)-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Intensive Care Med ; 47(2): 188-198, 2021 02.
Article in English | MEDLINE | ID: covidwho-1384370
Semantic information from SemMedBD (by NLM)
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ABSTRACT

PURPOSE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / Pneumonia, Ventilator-Associated / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-020-06323-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / Pneumonia, Ventilator-Associated / COVID-19 Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Prognostic study / Randomized controlled trials / Risk factors Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-020-06323-9