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Early Bacterial Identification among Intubated Patients with COVID-19 or Influenza Pneumonia: A European Multicenter Comparative Clinical Trial.
Rouzé, Anahita; Martin-Loeches, Ignacio; Povoa, Pedro; Metzelard, Matthieu; Du Cheyron, Damien; Lambiotte, Fabien; Tamion, Fabienne; Labruyere, Marie; Boulle Geronimi, Claire; Nieszkowska, Ania; Nyunga, Martine; Pouly, Olivier; Thille, Arnaud W; Megarbane, Bruno; Saade, Anastasia; Diaz, Emili; Magira, Eleni; Llitjos, Jean-François; Cilloniz, Catia; Ioannidou, Iliana; Pierre, Alexandre; Reignier, Jean; Garot, Denis; Kreitmann, Louis; Baudel, Jean-Luc; Fartoukh, Muriel; Plantefeve, Gaëtan; Beurton, Alexandra; Asfar, Pierre; Boyer, Alexandre; Mekontso-Dessap, Armand; Makris, Demosthenes; Vinsonneau, Christophe; Floch, Pierre-Edouard; Weiss, Nicolas; Ceccato, Adrian; Artigas, Antonio; Bouchereau, Mathilde; Duhamel, Alain; Labreuche, Julien; Nseir, Saad.
  • Rouzé A; CHU de Lille, Médecine Intensive Réanimation, Lille, France.
  • Martin-Loeches I; INSERM U1285, Université de Lille, CNRS, UMR 8576, Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France.
  • Povoa P; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St. James's Hospital, Dublin, Ireland.
  • Metzelard M; Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland.
  • Du Cheyron D; Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain.
  • Lambiotte F; Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal.
  • Tamion F; NOVA Medical School, CHRC, New University of Lisbon, Portugal.
  • Labruyere M; Research Unit of Clinical Epidemiology, Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
  • Boulle Geronimi C; Service de Médecine Intensive Réanimation, CHU Amiens Picardie, Amiens, France.
  • Nieszkowska A; Department of Medical Intensive Care, Caen University Hospital, Caen, France.
  • Nyunga M; Service de réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France.
  • Pouly O; Medical Intensive Care Unit, Rouen University Hospital, UNIROUEN, INSERM U1096, FHU- REMOD-VHF, Rouen, France.
  • Thille AW; Department of Intensive Care, François Mitterrand University Hospital, Dijon, France.
  • Megarbane B; Service de réanimation et de soins intensifs, Centre Hospitalier de Douai, Douai, France.
  • Saade A; Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Diaz E; Service de réanimation, Centre Hospitalier de Roubaix, Roubaix, France.
  • Magira E; Service de médecine intensive réanimation, Hôpital Saint Philibert GHICL, Université Catholique, Lille, France.
  • Llitjos JF; CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France.
  • Cilloniz C; Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris University, Paris, France.
  • Ioannidou I; Service de médecine intensive réanimation, Hôpital Saint-Louis, Paris, France.
  • Pierre A; Critical Care Department, Hospital Universitari Parc Tauli, Sabadell, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain.
  • Reignier J; First Department of Critical Care Medicine, National and Kapodistrian University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
  • Garot D; Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Kreitmann L; Department of Pulmonology, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain.
  • Baudel JL; First Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Sotiria Chest Hospital, Athens, Greece.
  • Fartoukh M; Service de réanimation polyvalente, Centre Hospitalier de Lens, Lens, France.
  • Plantefeve G; Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France.
  • Beurton A; Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, Tours, France.
  • Asfar P; Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
  • Boyer A; Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Mekontso-Dessap A; Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Makris D; Service de réanimation polyvalente, CH Victor Dupouy, Argenteuil, France.
  • Vinsonneau C; Service de Médecine Intensive Réanimation et Pneumologie, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Floch PE; INSERM UMRS, Neurophysiologie respiratoire expérimentale et clinique, Hôpital Pitié Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • Weiss N; Département de Médecine Intensive Réanimation, CHU d'Angers, Angers, France.
  • Ceccato A; Service de médecine intensive réanimation, CHU de Bordeaux, Bordeaux, France.
  • Artigas A; Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Université Paris Est Créteil, CARMAS, INSERM U955, Institut Mondor de recherche Biomédicale, Assistance Publique-Hôpitaux de Paris, Créteil, France.
  • Bouchereau M; Intensive Care Unit, University Hospital of Larissa, University of Thessaly, Biopolis Larissa, Greece.
  • Duhamel A; Intensive Care Unit, Béthune Beuvry Hospital Center, Béthune, France.
  • Labreuche J; Service de réanimation, Hôpital Duchenne, Boulogne-sur-Mer, France.
  • Nseir S; Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Hôpital de la Pitié-Salpêtrière, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France.
Am J Respir Crit Care Med ; 204(5): 546-556, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1416749
Semantic information from SemMedBD (by NLM)
1. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
2. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
3. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
4. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
5. early identification compared_with IMPACT gene
Subject
early identification
Predicate
compared_with
Object
IMPACT gene
6. Pneumonia OCCURS_IN Patients
Subject
Pneumonia
Predicate
OCCURS_IN
Object
Patients
7. Invasive mechanical ventilation NOS ADMINISTERED_TO Patients
Subject
Invasive mechanical ventilation NOS
Predicate
ADMINISTERED_TO
Object
Patients
8. 2019 novel coronavirus PROCESS_OF Patients
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Patients
9. Coinfection PROCESS_OF Patients
Subject
Coinfection
Predicate
PROCESS_OF
Object
Patients
10. Influenza PROCESS_OF Patients
Subject
Influenza
Predicate
PROCESS_OF
Object
Patients
11. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
12. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
13. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
14. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
15. early identification compared_with IMPACT gene
Subject
early identification
Predicate
compared_with
Object
IMPACT gene
16. Pneumonia OCCURS_IN Patients
Subject
Pneumonia
Predicate
OCCURS_IN
Object
Patients
17. Invasive mechanical ventilation NOS ADMINISTERED_TO Patients
Subject
Invasive mechanical ventilation NOS
Predicate
ADMINISTERED_TO
Object
Patients
18. 2019 novel coronavirus PROCESS_OF Patients
Subject
2019 novel coronavirus
Predicate
PROCESS_OF
Object
Patients
19. Coinfection PROCESS_OF Patients
Subject
Coinfection
Predicate
PROCESS_OF
Object
Patients
20. Influenza PROCESS_OF Patients
Subject
Influenza
Predicate
PROCESS_OF
Object
Patients
ABSTRACT
Rationale Early empirical antimicrobial treatment is frequently prescribed to critically ill patients with coronavirus disease (COVID-19) based on Surviving Sepsis Campaign guidelines.

Objectives:

We aimed to determine the prevalence of early bacterial identification in intubated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, as compared with influenza pneumonia, and to characterize its microbiology and impact on outcomes.

Methods:

A multicenter retrospective European cohort was performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation >48 hours were eligible if they had SARS-CoV-2 or influenza pneumonia at ICU admission. Bacterial identification was defined by a positive bacterial culture within 48 hours after intubation in endotracheal aspirates, BAL, blood cultures, or a positive pneumococcal or legionella urinary antigen test.Measurements and Main

Results:

A total of 1,050 patients were included (568 in SARS-CoV-2 and 482 in influenza groups). The prevalence of bacterial identification was significantly lower in patients with SARS-CoV-2 pneumonia compared with patients with influenza pneumonia (9.7 vs. 33.6%; unadjusted odds ratio, 0.21; 95% confidence interval [CI], 0.15-0.30; adjusted odds ratio, 0.23; 95% CI, 0.16-0.33; P < 0.0001). Gram-positive cocci were responsible for 58% and 72% of coinfection in patients with SARS-CoV-2 and influenza pneumonia, respectively. Bacterial identification was associated with increased adjusted hazard ratio for 28-day mortality in patients with SARS-CoV-2 pneumonia (1.57; 95% CI, 1.01-2.44; P = 0.043). However, no significant difference was found in the heterogeneity of outcomes related to bacterial identification between the two study groups, suggesting that the impact of coinfection on mortality was not different between patients with SARS-CoV-2 and influenza.

Conclusions:

Bacterial identification within 48 hours after intubation is significantly less frequent in patients with SARS-CoV-2 pneumonia than patients with influenza pneumonia.Clinical trial registered with www.clinicaltrials.gov (NCT04359693).
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Influenza, Human / Coinfection / COVID-19 Type of study: Controlled clinical trial / Diagnostic study / Clinical Practice Guide / Observational study / Randomized controlled trials / Risk factors Topics: Long Covid Limits: Adult / Humans Language: English Journal: Am J Respir Crit Care Med Journal subject: Critical Care Year: 2021 Document Type: Article Affiliation country: Rccm.202101-0030OC

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Influenza, Human / Coinfection / COVID-19 Type of study: Controlled clinical trial / Diagnostic study / Clinical Practice Guide / Observational study / Randomized controlled trials / Risk factors Topics: Long Covid Limits: Adult / Humans Language: English Journal: Am J Respir Crit Care Med Journal subject: Critical Care Year: 2021 Document Type: Article Affiliation country: Rccm.202101-0030OC