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Luyt, Charles-Edouard; Sahnoun, Tarek; Gautier, Melchior; Vidal, Pauline; Burrel, Sonia; Pineton de Chambrun, Marc; Chommeloux, Juliette; Desnos, Cyrielle; Arzoine, Jeremy; Nieszkowska, Ania; Bréchot, Nicolas; Schmidt, Matthieu; Hekimian, Guillaume; Boutolleau, David; Robert, Jérôme; Combes, Alain; Chastre, Jean

Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study

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  • Media type: E-Article
  • Title: Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study
  • Contributor: Luyt, Charles-Edouard; Sahnoun, Tarek; Gautier, Melchior; Vidal, Pauline; Burrel, Sonia; Pineton de Chambrun, Marc; Chommeloux, Juliette; Desnos, Cyrielle; Arzoine, Jeremy; Nieszkowska, Ania; Bréchot, Nicolas; Schmidt, Matthieu; Hekimian, Guillaume; Boutolleau, David; Robert, Jérôme; Combes, Alain; Chastre, Jean
  • imprint: Springer Science and Business Media LLC, 2020
  • Published in: Annals of Intensive Care
  • Language: English
  • DOI: 10.1186/s13613-020-00775-4
  • ISSN: 2110-5820
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>The data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited. We performed this retrospective cohort study to assess frequency, clinical characteristics, responsible pathogens, and outcomes of VAP in patients COVID-19 pneumonia requiring MV between March 12th and April 24th, 2020 (all had RT-PCR-confirmed SARS-CoV-2 infection). Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring ECMO were compared with an historical cohort of 45 patients with severe influenza-associated ARDS requiring ECMO admitted to the same ICU during the preceding three winter seasons.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Among 50 consecutive patients with Covid-19-associated ARDS requiring ECMO included [median (IQR) age 48 (42–56) years; 72% male], 43 (86%) developed VAP [median (IQR) MV duration before the first episode, 10 (8–16) days]. VAP-causative pathogens were predominantly Enterobacteriaceae (70%), particularly inducible AmpC-cephalosporinase producers (40%), followed by <jats:italic>Pseudomonas aeruginosa</jats:italic> (37%). VAP recurred in 34 (79%) patients and 17 (34%) died. Most recurrences were relapses (i.e., infection with the same pathogen), with a high percentage occurring on adequate antimicrobial treatment. Estimated cumulative incidence of VAP, taking into account death and extubation as competing events, was significantly higher in Covid-19 patients than in influenza patients (<jats:italic>p</jats:italic> = 0.002). Despite a high <jats:italic>P. aeruginosa</jats:italic>-VAP rate in patients with influenza-associated ARDS (54%), the pulmonary infection recurrence rate was significantly lower than in Covid-19 patients. Overall mortality was similar for the two groups.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Patients with severe Covid-19-associated ARDS requiring ECMO had a very high late-onset VAP rate. Inducible AmpC-cephalosporinase-producing Enterobacteriaceae and <jats:italic>Pseudomonas aeruginosa</jats:italic> frequently caused VAP, with multiple recurrences and difficulties eradicating the pathogen from the lung.</jats:p> </jats:sec>
  • Access State: Open Access