Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study

Bilbay, Burak; Altintas, Neriman; YÖRÜK, FÜGEN; Ferlicolak, Leyla; Sarıcaoğlu, Elif mukime

doi:10.5578/tt.20239906

Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study

Leyla TALAN, (Ankara Üniversitesi Tıp Fakültesi, Dahiliye Bölümü, Yoğun Bakım Bölümü, Ankara, Türkiye)

Elif M. SARICIOĞLU, (Ankara Üniversitesi, Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara, Türkiye)

Burak BİLBAY, (Ankara Üniversitesi, Tıp Fakültesi, Dahiliye Anabilim Dalı, Ankara, Türkiye)

Neriman Defne ALTINTAŞ, (Ankara Üniversitesi Tıp Fakültesi, Dahiliye Bölümü, Yoğun Bakım Bölümü, Ankara, Türkiye)

Fügen YÖRÜK (Ankara Üniversitesi, Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara, Türkiye)

Tüberküloz ve Toraks

7 1

Yıl: 2023 Cilt: 71 Sayı: 1 Sayfa Aralığı: 41 - 47 Metin Dili: İngilizce DOI: 10.5578/tt.20239906 İndeks Tarihi: 30-05-2023

Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study

Öz:

Introduction: We aimed to evaluate ventilator-associated pneumonia (VAP) incidence rate, risk factors, and isolated microorganisms in COVID-19 patients as the primary endpoint. Evaluation of VAP-associated intensive care unit (ICU) and hospital mortalities was the secondary endpoint. Materials and Methods: Records of patients admitted between March 2020- June 2021 to our pandemic ICU were reviewed and COVID-19 patients with VAP and non-VAP were evaluated retrospectively. Comorbidities, manage- ment, length of ICU stay, and outcomes of VAP and non-VAP patients, as well as risk factors for VAP mortality, were identified. Results: During the study period, 254 patients were admitted to the ICU. After the exclusion, the data of 208 patients were reviewed. In total, 121 patients required invasive mechanical ventilation, with 78 (64.5%) developing VAP. Length of ICU and hospital stays were longer in VAP patients (p< 0.01 and p< 0.01 respectively). Steroid use was higher in VAP patients, although it was not statistically significant (p= 0.06). APACHE II score (p< 0.01) was higher in non-VAP patients. ICU mortality was high in both groups (VAP 70%, non-VAP 77%). VAP mortality was higher in males (p= 0.03) and in patients who requ- ired renal replacement therapy (p= 0.01). Length of ICU stay (p= 0.04), and length of hospital stay (p< 0.01) were both high in VAP survivors. The most common isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients and most of them were extensively drug-resistant. Conclusion: Critically ill COVID-19 patients who required invasive mechani- cal ventilation developed VAP frequently. The length of ICU stay was longer in patients who developed VAP and ICU mortality was high in both VAP and non-VAP patients. The length of hospital and ICU stays among VAP survivors were also considerably high which is probably related to the long recovery period of COVID-19. The most frequently isolated microorganisms were Acinetobacter spp. and Klebsiella spp. in VAP patients.

Anahtar Kelime:

COVID-19 hastalarında ventilatör ilişkili pnömoni: Retrospektif kohort çalışması

Öz:

Giriş: Çalışmamızda primer sonlanım noktası olarak COVID-19 hastalarında ventilatör ilişkili pnömoni (VİP) insidansını, risk faktörle- rini ve izole edilen mikroorganizmaları değerlendirmeyi amaçladık. VİP ile ilişkili yoğun bakım ünitesi (YBÜ) ve hastane ölümlerinin değerlendirilmesi ikincil sonlanım noktasıydı. Materyal ve Metod: Mart 2020 ve Haziran 2021 tarihleri arasında pandemi yoğun bakım ünitemize başvuran hastaların kayıtları incelenerek VİP olan ve olmayan COVID-19 hastaları retrospektif olarak değerlendirildi. VİP mortalitesi için risk faktörlerinin yanı sıra VİP olan ve olmayan hastaların komorbiditeleri, kullanılan tedaviler, YBÜ kalış süresi ve sonlanımları kaydedildi. Bulgular: Çalışma süresi boyunca 254 hasta yoğun bakıma kabul edildi. Dışlamadan sonra 208 hastanın verileri incelendi. Toplam 121 hastada invaziv mekanik ventilasyon uygulanmıştı ve 78 (%64.5) hastada VİP gelişmişti. VİP hastalarında yoğun bakım ve has- tanede kalış süreleri daha uzundu (sırasıyla p< 0.01 ve p< 0.01). İstatistiksel olarak anlamlı olmamakla birlikte VİP hastalarında ste- roid kullanımı daha yüksekti (p= 0.06). APACHE II skoru (p< 0.01) VİP gelişmeyen hastalarda daha yüksek saptandı. YBÜ mortalite- si her iki grupta da yüksekti (VİP %70, VİP dışı %77). VİP mortalitesi erkeklerde (p= 0.03) ve renal replasman tedavisi gereken has- talarda (p= 0.01) daha yüksekti. Yoğun bakımda kalış süresi (p= 0.04) ve hastanede kalış süresi (p< 0.01) sağ kalanlarda yüksekti. En sık izole edilen mikroorganizmalar Acinetobacter spp. ve Klebsiella spp. olarak izlendi ve bunların çoğu bir veya iki antibiyotik grubu hariç, hepsine dirençli mikroorganizmalardı. Sonuç: İnvaziv mekanik ventilasyona ihtiyaç duyan kritik COVID-19 hastalarında sıklıkla VİP geliştiği izlendi. VİP gelişen hastalarda yoğun bakımda kalış süresi uzundu ve hem VİP olan hem de olmayan hastalarda YBÜ mortalitesi yüksekti. Sağ kalan VİP hastalarında hastanede ve yoğun bakımda kalış süreleri de oldukça yüksekti, bu muhtemelen COVID-19’un uzun iyileşme süresiyle ilişkilidir. En sık izole edilen mikroorganizmalar Acinetobacter türleri ve Klebsiella türleri olmuştur.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospi- tal-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63(5): e61-111. https://doi. org/10.1093/cid/ciw353
2. Melsen WG, Rovers MM, Groenwold RH, Bergmans DC, Camus C, Bauer TT, et al. Attributable mortality of ventila- tor-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013; 13(8): 665-71. https://doi.org/10.1016/ S1473-3099(13)70081-1
3. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospi- talized with COVID-19 in the New York City Area. JAMA 2020; 323(20): 2052-9. https://doi.org/10.1001/ jama.2020.6775
4. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20.133 UK patients in hos- pital with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study. BMJ 2020; 369: m1985. https://doi. org/10.1136/bmj.m1985
5. Wicky PH, d’Humières C, Timsit JF. How common is ven- tilator-associated pneumonia after Coronavirus dis- ease-2019? Curr Opin Infect Dis 2022; 35(2): 170-5. https://doi.org/10.1097/QCO.0000000000000817
6. Gündoğan K, Akbudak İH, Hancı P, Halaçlı B, Temel Ş, Güllü Z, et al. Clinical outcomes and independent risk factors for 90-day mortality in critically ill patients with respiratory failure infected with SARS-CoV-2: A multi- center study in Turkish intensive care units. Balkan Med J 2021; 38(5): 296-303. https://doi.org/10.5152/balkan- medj.2021.21188
7. Rouzé A, Martin-Loeches I, Povoa P, Makris D, Artigas A, Bouchereau M, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: A European multicenter cohort study. Intensive Care Med 2021; 47(2): 188-98. https:// doi.org/10.1007/s00134-020-06323-9
8. Razazi K, Arrestier R, Haudebourg AF, Benelli B, Carteaux G, Decousser JW, et al. Risks of ventilator-associated pneu- monia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease. Crit Care 2020; 24(1): 699. https://doi.org/10.1186/s13054-020-03417-0
9. Lamouche-Wilquin P, Souchard J, Pere M, Raymond M, Asfar P, Darreau C, et al. Early steroids and ventilator-asso- ciated pneumonia in COVID-19-related ARDS. Crit Care 2022; 26(1): 233. https://doi.org/10.1186/s13054-022- 04097-8
10. Bassetti M, Righi E, Vena A, Graziano E, Russo A, Peghin M. Risk stratification and treatment of ICU-acquired pneu- monia caused by multidrug-resistant/extensively drug-re- sistant/pandrug-resistant bacteria. Curr Opin Crit Care 2018; 24(5): 385-93. https://doi.org/10.1097/ MCC.0000000000000534
11. COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID- 19: A prospective cohort study. Intensive Care Med 2021; 47(1): 60-73. https://doi.org/10.1007/s00134-020- 06294-x
12. Blonz G, Kouatchet A, Chudeau N, Pontis E, Lorber J, Lemeur A, et al. Epidemiology and microbiology of ventila- tor-associated pneumonia in COVID-19 patients: A multi- center retrospective study in 188 patients in an uninundat- ed French region. Crit Care 2021; 25(1): 72. https://doi. org/10.1186/s13054-021-03493-w
13. Nseir S, Martin-Loeches I, Povoa P, Metzelard M, Du Cheyron D, Lambiotte F, et al. Relationship between ventila- tor-associated pneumonia and mortality in COVID-19 patients: A planned ancillary analysis of the coVAPid cohort. Crit Care 2021; 25(1): 177. https://doi.org/10.1186/ s13054-021-03588-4
14. Gragueb-Chatti I, Lopez A, Hamidi D, Guervilly C, Loundou A, Daviet F, et al. Impact of dexamethasone on the inci- dence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechan- ical ventilation: A multicenter retrospective study. Ann Intensive Care 2021; 11(1): 87. https://doi.org/10.1186/ s13613-021-00876-8
15. Scaravilli V, Guzzardella A, Madotto F, Beltrama V, Muscatello A, Bellani G, et al. Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: A propensi- ty-matched cohort study. Crit Care 2022; 26(1): 176. https://doi.org/10.1186/s13054-022-04049-2
16. Gordon AC, Mouncey PR, Al-Beidh F, Rowan KM, Nichol AD, Arabi YM, et al. Interleukin-6 receptor antagonists in critically ill patients with COVID-19. N Engl J Med 2021; 384(16): 1491-502. https://doi.org/10.1056/ NEJMoa2100433
17. RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): A ran- domised, controlled, open-label, platform trial. Lancet 2021; 397(10285): 1637-45. https://doi.org/10.1016/S0140- 6736(21)00676-0
18. Rouyer M, Strazzulla A, Youbong T, Tarteret P, Pitsch A, de Pontfarcy A, et al. Ventilator-associated pneumonia in COVID-19 patients: A retrospective cohort study. Antibiotics 2021; 10(8). https://doi.org/10.3390/antibiotics10080988
19. Giacobbe DR, Battaglini D, Enrile EM, Dentone C, Vena A, Robba C, et al. Incidence and prognosis of ventilator-asso- ciated pneumonia in critically Ill patients with COVID-19: A multicenter study. J Clin Med 2021; 10(4). https://doi. org/10.3390/jcm10040555
20. Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, et al. Ventilator-associated pneumonia in critical- ly ill patients with COVID-19. Crit Care 2021; 25(1): 25. https://doi.org/10.1186/s13054-021-03460-5
21. Rollas K, Ersan G, Emgin O, Caliskan T, Yavuz T, Sarac O. Evaluation of microorganisms isolated from endotracheal aspirate cultures in patients with and without COVID-19 in the intensive care unit: Single-centre retrospective analysis. J Crit Intensive Care 2022; 13: 66-72. https://doi. org/10.37678/dcybd.2022.3156
22. Polly M, de Almeida BL, Lennon RP, Cortês MF, Costa SF, Guimarães T. Impact of the COVID-19 pandemic on the incidence of multidrug-resistant bacterial infections in an acute care hospital in Brazil. Am J Infect Control 2022; 50(1): 32-8. https://doi.org/10.1016/j.ajic.2021.09.018

APA	Ferlicolak L, Sarıcaoğlu E, Bilbay B, Altintas N, YÖRÜK F (2023). Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. , 41 - 47. 10.5578/tt.20239906
Chicago	Ferlicolak Leyla,Sarıcaoğlu Elif mukime,Bilbay Burak,Altintas Neriman,YÖRÜK FÜGEN Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. (2023): 41 - 47. 10.5578/tt.20239906
MLA	Ferlicolak Leyla,Sarıcaoğlu Elif mukime,Bilbay Burak,Altintas Neriman,YÖRÜK FÜGEN Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. , 2023, ss.41 - 47. 10.5578/tt.20239906
AMA	Ferlicolak L,Sarıcaoğlu E,Bilbay B,Altintas N,YÖRÜK F Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. . 2023; 41 - 47. 10.5578/tt.20239906
Vancouver	Ferlicolak L,Sarıcaoğlu E,Bilbay B,Altintas N,YÖRÜK F Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. . 2023; 41 - 47. 10.5578/tt.20239906
IEEE	Ferlicolak L,Sarıcaoğlu E,Bilbay B,Altintas N,YÖRÜK F "Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study." , ss.41 - 47, 2023. 10.5578/tt.20239906
ISNAD	Ferlicolak, Leyla vd. "Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study". (2023), 41-47. https://doi.org/10.5578/tt.20239906

APA	Ferlicolak L, Sarıcaoğlu E, Bilbay B, Altintas N, YÖRÜK F (2023). Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. Tüberküloz ve Toraks, 71(1), 41 - 47. 10.5578/tt.20239906
Chicago	Ferlicolak Leyla,Sarıcaoğlu Elif mukime,Bilbay Burak,Altintas Neriman,YÖRÜK FÜGEN Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. Tüberküloz ve Toraks 71, no.1 (2023): 41 - 47. 10.5578/tt.20239906
MLA	Ferlicolak Leyla,Sarıcaoğlu Elif mukime,Bilbay Burak,Altintas Neriman,YÖRÜK FÜGEN Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. Tüberküloz ve Toraks, vol.71, no.1, 2023, ss.41 - 47. 10.5578/tt.20239906
AMA	Ferlicolak L,Sarıcaoğlu E,Bilbay B,Altintas N,YÖRÜK F Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. Tüberküloz ve Toraks. 2023; 71(1): 41 - 47. 10.5578/tt.20239906
Vancouver	Ferlicolak L,Sarıcaoğlu E,Bilbay B,Altintas N,YÖRÜK F Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study. Tüberküloz ve Toraks. 2023; 71(1): 41 - 47. 10.5578/tt.20239906
IEEE	Ferlicolak L,Sarıcaoğlu E,Bilbay B,Altintas N,YÖRÜK F "Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study." Tüberküloz ve Toraks, 71, ss.41 - 47, 2023. 10.5578/tt.20239906
ISNAD	Ferlicolak, Leyla vd. "Ventilator associated pneumonia in COVID-19 patients: A retrospective cohort study". Tüberküloz ve Toraks 71/1 (2023), 41-47. https://doi.org/10.5578/tt.20239906