Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study
Luis Felipe Reyes, Alejandro Rodríguez, Yuli V. Fuentes, Sara Duque, Esteban García-Gallo, Alirio Bastidas, Cristian C. Serrano-Mayorga, Elsa D. Ibáñez-Prada, Gerard Moreno, Paula C. Ramirez-Valbuena, Gustavo A. Ospina‐Tascón, Glenn Hernández, Edwin Silva, Ana María Álvarez‐Díaz, Manuel Jibaja, Magdalena Vera-Alarcon, Emili Dı́az, María Bodi, Jordi Solé‐Violán, Ricard Ferrer, Antonio Albaya-Moreno, Lorenzo Socías, William Figueroa, Jose L. Lozano-Villanueva, Fabio Varón-Vega, Ángel Estella, Ana Loza-Vázquez, Ruth Jorge-García, Isabel Sancho, Manu Shankar‐Hari, Ignacio Martín‐Loeches, LIVEN-Covid-19, Luis A. Gorordo-Delsol, Ricardo Buitrago, Marcela Poveda, Lina Maria Saucedo, Elisa Estenssoro, Guillermo Ortíz, Nicolás Nín, Alfonso Jose Arango, Alvaro Aguilar, Andrea Lizeth Ayala, Andrea Viviana Bayona, Andrea Lizeth Ayala, A. Riquelme Rodríguez, Carol Viviana Aponte, Carolina Forero-Carreño, Conny Stefanny Muñoz, Cristian Augusto Estrada, Cristopher Romero, Danilo E. Trujillo González, Diego Holguín, Jesus Chavez-Villegas, Faure Rodriguez, Francisco J. Franco, Hernan Sánchez, Janett Vanessa Moncayo, Jennifer-Andrea Pinedo, Jesica Valeria Bravo, Jose David Cruz, José Ángel, Jovany Castro-Lara, Katherine M. Mantilla, L. FERNANDEZ GARCÍA, Lorena Pabón, Luis A. Lopez, Luis Fernando Mamani, Marisa Lucrecia Yupa, Valeria Catalina Quevedo, SEMICYUC Study Group, Andalucía, Ana Loza, Diego Matallana Zapata, Isabel Díaz Torres, Sonia Ibañez Cuadros, María Recuerda Núñez, Maria Luz Carmona Pérez, Jorge Gómez Ramos, Alba Villares Casas, María Luisa Cantón, José Javier González Contreras, Helena Pérez Chomón, Nerissa Álvarez Chicote, Alberto Sousa González, María De Alba Aparicio, Aragón, Ruth Jorge García, Laura Sánchez Montori, Sandra Herrero García, Paula Abansés Moreno, Carlos Mayordomo García, Tomás Mallor Bonet, Paula Omedas Bonafonte, Enric Franquesa Gonzalez, Nestor Bueno Vidales, Paula Ocabo Buil, C. Serón Arbeloa, Isabel Sancho, Pablo Guerrero Ibañez, Pablo Gutierrez
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.