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Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease.
Razazi, Keyvan; Arrestier, Romain; Haudebourg, Anne Fleur; Benelli, Brice; Carteaux, Guillaume; Decousser, Jean-Winoc; Fourati, Slim; Woerther, Paul Louis; Schlemmer, Frederic; Charles-Nelson, Anais; Botterel, Francoise; de Prost, Nicolas; Mekontso Dessap, Armand.
  • Razazi K; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France. keyvan.razazi@aphp.fr.
  • Arrestier R; UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France. keyvan.razazi@aphp.fr.
  • Haudebourg AF; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
  • Benelli B; UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
  • Carteaux G; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
  • Decousser JW; UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
  • Fourati S; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
  • Woerther PL; UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
  • Schlemmer F; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
  • Charles-Nelson A; UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
  • Botterel F; UPEC (Université Paris Est), INSERM, Unité U955, 94010, Créteil, France.
  • de Prost N; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, Contrôle, Epidémiologie et Prévention de l'Infection, CEPI, 94010, Créteil, France.
  • Mekontso Dessap A; AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, Département de Virologie, Bactériologie, Parasitologie-Mycologie, 94010, Créteil, France.
Crit Care ; 24(1): 699, 2020 12 18.
Article in English | MEDLINE | ID: covidwho-992531
ABSTRACT

BACKGROUND:

Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited.

METHODS:

We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS).

RESULTS:

We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization.

CONCLUSIONS:

In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Respiratory Distress Syndrome / Pneumonia, Ventilator-Associated / COVID-19 / Intensive Care Units Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Year: 2020 Document Type: Article Affiliation country: S13054-020-03417-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Respiratory Distress Syndrome / Pneumonia, Ventilator-Associated / COVID-19 / Intensive Care Units Type of study: Diagnostic study / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Year: 2020 Document Type: Article Affiliation country: S13054-020-03417-0