Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study
Anahita Rouzé
(1, 2)
,
Ignacio Martin-Loeches
(3, 4)
,
Pedro Povoa
(5)
,
Demosthenes Makris
(6)
,
Antonio Artigas
(7)
,
Mathilde Bouchereau
(1)
,
Fabien Lambiotte
(8)
,
Matthieu Metzelard
(9)
,
Pierre Cuchet
(10)
,
Claire Boulle Geronimi
(11)
,
Marie Labruyere
(12)
,
Fabienne Tamion
(13)
,
Martine Nyunga
,
Charles-Edouard Luyt
(14, 15)
,
Julien Labreuche
(16)
,
Olivier Pouly
(17)
,
Justine Bardin
(18)
,
Anastasia Saade
(19)
,
Pierre Asfar
(20)
,
Jean-Luc Baudel
(21, 22)
,
Alexandra Beurton
(23, 22)
,
Denis Garot
(24)
,
Iliana Ioannidou
(25)
,
Louis Kreitmann
(26)
,
Jean-François Llitjos
(27)
,
Eleni Magira
(28)
,
Bruno Mégarbane
(29, 30)
,
David Meguerditchian
(31)
,
Edgar Moglia
,
Armand Mekontso-Dessap
(32)
,
Jean Reignier
(33)
,
Matthieu Turpin
(34, 22)
,
Alexandre Pierre
,
Gaetan Plantefeve
(35)
,
Christophe Vinsonneau
,
Pierre-Edouard Floch
,
Nicolas Weiss
(23, 22)
,
Adrian Ceccato
(4)
,
Antoni Torres
(4, 7)
,
Alain Duhamel
(16)
,
Saad Nseir
(1, 2)
1
CHRU Lille -
Centre Hospitalier Régional Universitaire [CHU Lille]
2 LIRIC - Lille Inflammation Research International Center - U 995
3 St James's University Hospital
4 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
5 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
6 UTH - University of Thessaly [Volos]
7 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
8 Centre hospitalier [Valenciennes, Nord]
9 CHU Amiens-Picardie
10 CHU Caen
11 Centre Hospitalier [Douai, Nord]
12 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
13 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
14 Institut de cardiologie [CHU Pitié-Salpêtrière]
15 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
16 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
17 Hôpital Saint Philibert [Lomme]
18 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
19 AP-HP - Hopital Saint-Louis [AP-HP]
20 CHU Angers - Centre Hospitalier Universitaire d'Angers
21 CHU Saint-Antoine [AP-HP]
22 SU FM - Sorbonne Université - Faculté de Médecine
23 CHU Pitié-Salpêtrière [AP-HP]
24 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
25 NKUA - National and Kapodistrian University of Athens
26 HCL - Hospices Civils de Lyon
27 Unité de Soins Intensifs [CHU Cochin]
28 University of Athens Medical School [Athens]
29 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
30 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
31 CHU de Bordeaux Pellegrin [Bordeaux]
32 Hôpital Henri Mondor
33 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
34 CHU Tenon [AP-HP]
35 Centre Hospitalier Victor Dupouy
2 LIRIC - Lille Inflammation Research International Center - U 995
3 St James's University Hospital
4 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
5 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
6 UTH - University of Thessaly [Volos]
7 CIBERES - Centro de Investigación Biomédica en Red Enfermedades Respiratorias
8 Centre hospitalier [Valenciennes, Nord]
9 CHU Amiens-Picardie
10 CHU Caen
11 Centre Hospitalier [Douai, Nord]
12 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
13 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
14 Institut de cardiologie [CHU Pitié-Salpêtrière]
15 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
16 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
17 Hôpital Saint Philibert [Lomme]
18 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
19 AP-HP - Hopital Saint-Louis [AP-HP]
20 CHU Angers - Centre Hospitalier Universitaire d'Angers
21 CHU Saint-Antoine [AP-HP]
22 SU FM - Sorbonne Université - Faculté de Médecine
23 CHU Pitié-Salpêtrière [AP-HP]
24 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
25 NKUA - National and Kapodistrian University of Athens
26 HCL - Hospices Civils de Lyon
27 Unité de Soins Intensifs [CHU Cochin]
28 University of Athens Medical School [Athens]
29 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
30 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
31 CHU de Bordeaux Pellegrin [Bordeaux]
32 Hôpital Henri Mondor
33 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
34 CHU Tenon [AP-HP]
35 Centre Hospitalier Victor Dupouy
Fabienne Tamion
- Fonction : Auteur
- PersonId : 1327347
- ORCID : 0000-0002-3708-1460
- IdRef : 060290064
Martine Nyunga
- Fonction : Auteur
Pierre Asfar
- Fonction : Auteur
- PersonId : 991981
- ORCID : 0000-0002-1175-9149
Bruno Mégarbane
- Fonction : Auteur
- PersonId : 806590
- ORCID : 0000-0002-2522-2764
- IdRef : 07419190X
Edgar Moglia
- Fonction : Auteur
Armand Mekontso-Dessap
- Fonction : Auteur
- PersonId : 1188370
- ORCID : 0000-0001-5961-5577
- IdRef : 130964603
Alexandre Pierre
- Fonction : Auteur
- PersonId : 762822
- IdRef : 174565208
Christophe Vinsonneau
- Fonction : Auteur
Pierre-Edouard Floch
- Fonction : Auteur
Saad Nseir
- Fonction : Auteur
- PersonId : 910837
- ORCID : 0000-0002-7618-0357
- IdRef : 103027351
Résumé
Purpose: Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI.
Methods: Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models.
Results: 1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp.
Conclusions: The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates.