TY - JOUR
AU - Reyes, Luis Felipe
AU - Rodriguez, Alejandro
AU - Fuentes, Yuli V.
AU - Duque, Sara
AU - Garcia-Gallo, Esteban
AU - Bastidas, Alirio
AU - Serrano-Mayorga, Cristian C
AU - Ibáñez-Prada, Elsa D
AU - Moreno, Gerard
AU - Ramirez-Valbuena, Paula C
AU - Ospina-Tascon, Gustavo
AU - Hernandez, Glenn
AU - Silva, Edwin
AU - Díaz, Ana Maria
AU - Jibaja, Manuel
AU - Vera-Alarcon, Magdalena
AU - Díaz, Emili
AU - Bodí, María
AU - Solé-Violán, Jordi
AU - Ferrer, Ricard
AU - Albaya-Moreno, Antonio
AU - Socias, Lorenzo
AU - Figueroa, William
AU - Lozano-Villanueva, Jose L
AU - LIVEN-COVID-19
AU - SEMICYUC Study Group
PY - 2023
DA - April
TI - Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study
JO - Scientific Reports
VL - 13
DO - https://doi.org/10.1038/s41598-023-32265-5
AB - Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
PB - Springer Nature
UR - https://www.research.ed.ac.uk/en/publications/23a95414-bccb-44f4-9380-69cce8a61693
KW - Coronavirus (COVID-19)
KW - Hospital care
ER