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  3. Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Reyes, L.F.
  • Rodríguez, A.
  • Fuentes, Y.V.
  • Duque, S.
  • García-Gallo, E.
  • Bastidas, A.
  • Serrano-Mayorga, C.C.
  • Ibáñez-Prada, E.D.
  • Moreno, G.
  • Ramirez-Valbuena, P.C.
  • Ospina-Tascón, G.
  • Hernández, G.
  • Silva-Monsalve, E.
  • Diaz, A.M.
  • Jibaja, M.
  • Vera, M.
  • Díaz, E.
  • Bodí, M.
  • Solé-Violán, J.
  • Ferrer-Roca, R.
  • Albaya-Moreno, A.
  • Socías, L.
  • Figueroa, W.
  • Lozano-Villanueva, J.L.
  • Varón-Vega, F.
  • Estella-García, Á.
  • Loza-Vázquez, A.
  • Jorge-García, R.N.
  • Sancho, I.
  • Shankar-Hari, M.
  • Martín-Loeches, I.
  • Quevedo, V.C.
  • Yupa, M.L.
  • Mamani, L.F.
  • Lopez, L.A.
  • Pabón, L.
  • García, L.
  • Mantilla, K.A.
  • Castro-Lara, J.
  • Angel, J.M.
  • Cruz, J.D.
  • Bravo, J.V.
  • Pinedo, J.A.
  • Moncayo, J.V.
  • Sánchez, H.
  • Franco, F.
  • Rodriguez, F.
  • Chávez-Villegas, J.
  • Holguín, D.
  • Trujillo, D.
  • Romero, C.
  • Estrada, C.A.
  • Muñoz, C.S.
  • Forero-Carreño, C.
  • Aponte, C.V.
  • Rodriguez, A.
  • Ayala, A.L.
  • Bayona, A.V.
  • Aguilar, A.
  • Arango, A.J.
  • Nín, N.
  • Ortiz-Ruiz, G.
  • Estenssoro, E.
  • Saucedo, L.M.
  • Poveda, M.
  • Buitrago, R.
  • Gorordo, L.A.
  • Guasch, N.
  • Ribas, A.M.
  • Ortíz, A.
  • Cabreara, J.F.
  • Romero, J.
  • Albert, L.
  • Bisbal, E.
  • Mas, S.
  • Navarro-Ripoll, R.
  • Soriano, G.
  • Gimenez, J.
  • Fayos, L.
  • Cortés, M.L.B.
  • Díaz, M.J.
  • Lazaro, A.S.
  • Franco Serrano, J.F.
  • Monleón, N.C.
  • Algarra, V.M.
  • Gómez, M.C.
  • Montero, V.R.
  • Garces, H.H.
  • Muncharaz, A.B.
  • Montell, M.P.
  • de la Guía Ortega, S.
  • Sánchez, V.G.
  • Bosch, L.B.
  • Aguilar, A.L.

Grupos

Abstract

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. © The Author(s) 2023.

Datos de la publicación

ISSN/ISSNe:
2045-2322, 2045-2322

SCIENTIFIC REPORTS  NATURE PUBLISHING GROUP

Tipo:
Article
Páginas:
-
PubMed:
37085552
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
1,005 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 22

Citas Recibidas en Scopus: 20

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Keywords

  • artificial ventilation; bronchitis; clinical trial; complication; coronavirus disease 2019; human; intensive care unit; mechanical ventilator; multicenter study; prospective study; respiratory tract infection; risk factor; Severe acute respiratory syndrome coronavirus 2; ventilator associated pneumonia; Bronchitis; COVID-19; Humans; Intensive Care Units; Pneumonia, Ventilator-Associated; Prospective Studies; Respiration, Artificial; Respiratory Tract Infections; Risk Factors; SARS-CoV-2; Ventilators, Mechanical

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