Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: a propensity-matched cohort study DOI Creative Commons
Vittorio Scaravilli, Amedeo Guzzardella, Fabiana Madotto

et al.

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: June 13, 2022

To assess the impact of treatment with steroids on incidence and outcome ventilator-associated pneumonia (VAP) in mechanically ventilated COVID-19 patients.Propensity-matched retrospective cohort study from February 24 to December 31, 2020, 4 dedicated Intensive Care Units (ICU) Lombardy (Italy).Adult consecutive patients were subdivided into two groups: (1) treated low-dose corticosteroids (dexamethasone 6 mg/day intravenous for 10 days) (DEXA+); (2) not (DEXA-). A propensity score matching procedure (1:1 ratio) identified patients' cohorts based on: age, weight, PEEP Level, PaO2/FiO2 ratio, non-respiratory Sequential Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), C reactive protein plasma concentration at admission, sex admission hospital (exact matching).Dexamethasone days admission.Seven hundred thirty-nine included, propensity-score groups 158 subjects each. Eighty-nine (56%) DEXA+ versus 55 (34%) DEXA- developed a VAP (RR 1.61 (1.26-2.098), p = 0.0001), after similar time hospitalization, ICU intubation. had higher crude rate (49.58 (49.26-49.91) vs. 31.65 (31.38-31.91)VAP*1000/pd), (IRR 1.57 (1.55-1.58), < 0.0001) risk (HR 1.81 (1.31-2.50), 0.0003), longer LOS invasive mechanical ventilation but mortality 1.17 (0.85-1.63), 0.3332). VAPs similarly due G+ bacteria (mostly Staphylococcus aureus) G- Enterobacterales). Forty-one (28%) multi-drug resistant bacteria. was associated almost doubled ventilation, increased 1.64 [1.02-2.65], 0.040) no differences among groups.Critically ill are high VAP, frequently caused by multidrug-resistant bacteria, is corticosteroid treatment.NCT04388670, retrospectively registered May 14, 2020.

Language: Английский

The interface between COVID-19 and bacterial healthcare-associated infections DOI Creative Commons
Ronan O’Toole

Clinical Microbiology and Infection, Journal Year: 2021, Volume and Issue: 27(12), P. 1772 - 1776

Published: June 7, 2021

Language: Английский

Citations

163
Antimicrobial resistance (AMR) in COVID-19 patients: a systematic review and meta-analysis (November 2019–June 2021) DOI Creative Commons
Ruwandi Kariyawasam, Danielle Julien,

Dana C. Jelinski

et al.

Antimicrobial Resistance and Infection Control, Journal Year: 2022, Volume and Issue: 11(1)

Published: March 7, 2022

Pneumonia from SARS-CoV-2 is difficult to distinguish other viral and bacterial etiologies. Broad-spectrum antimicrobials are frequently prescribed patients hospitalized with COVID-19 which potentially acts as a catalyst for the development of antimicrobial resistance (AMR).

Language: Английский

Citations

156
Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study DOI Open Access
Alexis Tabah, Niccolò Buetti,

Quentin Staiquly

et al.

Intensive Care Medicine, Journal Year: 2023, Volume and Issue: 49(2), P. 178 - 190

Published: Feb. 1, 2023

Language: Английский

Citations

148
Gut microbiome dysbiosis in antibiotic-treated COVID-19 patients is associated with microbial translocation and bacteremia DOI Creative Commons
Lucie Bernard, Mericien Venzon, Jon Klein

et al.

Nature Communications, Journal Year: 2022, Volume and Issue: 13(1)

Published: Nov. 1, 2022

Abstract Although microbial populations in the gut microbiome are associated with COVID-19 severity, a causal impact on patient health has not been established. Here we provide evidence that dysbiosis is translocation of bacteria into blood during COVID-19, causing life-threatening secondary infections. We first demonstrate SARS-CoV-2 infection induces mice, which correlated alterations to Paneth cells and goblet cells, markers barrier permeability. Samples collected from 96 patients at two different clinical sites also revealed substantial dysbiosis, including blooms opportunistic pathogenic bacterial genera known include antimicrobial-resistant species. Analysis culture results testing for bloodstream infections paired data indicates may translocate systemic circulation patients. These consistent direct role enabling dangerous COVID-19.

Language: Английский

Citations

137
Antimicrobial resistance in patients with COVID-19: a systematic review and meta-analysis DOI Creative Commons
Bradley J. Langford, Miranda So,

Marina Simeonova

et al.

The Lancet Microbe, Journal Year: 2023, Volume and Issue: 4(3), P. e179 - e191

Published: Feb. 1, 2023

BackgroundFrequent use of antibiotics in patients with COVID-19 threatens to exacerbate antimicrobial resistance. We aimed establish the prevalence and predictors bacterial infections resistance COVID-19.MethodsWe did a systematic review meta-analysis studies co-infections (identified within ≤48 h presentation) secondary (>48 after outpatients or hospitalised COVID-19. searched WHO Research Database identify cohort studies, case series, case-control trials, randomised controlled trials populations at least 50 published any language between Jan 1, 2019, Dec 2021. Reviews, editorials, letters, pre-prints, conference proceedings were excluded, as which infection was not microbiologically confirmed (or via nasopharyngeal swab only). screened titles abstracts papers identified by our search, then assessed full text potentially relevant articles. reported pooled doing random-effects meta-regression. Our primary outcomes co-infection infection, antibiotic-resistant pathogens among laboratory-confirmed infections. The study protocol registered PROSPERO (CRD42021297344).FindingsWe included 148 362 976 patients, done December, May, 5·3% (95% CI 3·8–7·4), whereas 18·4% (14·0–23·7). 42 (28%) comprehensive data for Among people infections, proportion that resistant antimicrobials 60·8% 38·6–79·3), isolates 37·5% (26·9–49·5). Heterogeneity organisms substantial (I2=95%).InterpretationAlthough infrequently assessed, is highly prevalent Future research surveillance assessing effect on patient population level are urgently needed.FundingWHO.

Language: Английский

Citations

106
Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia: A Literature Review DOI Creative Commons

Mihnea Miron,

Mihaela Blaj,

Irina Ristescu

et al.

Microorganisms, Journal Year: 2024, Volume and Issue: 12(1), P. 213 - 213

Published: Jan. 20, 2024

Hospital-acquired pneumonia (HAP) and its subtype, ventilator-associated (VAP), remain two significant causes of morbidity mortality worldwide, despite the better understanding pathophysiological mechanisms, etiology, risk factors, preventive methods (bundle care principles) supportive care. Prior detection factors combined with a clear clinical judgement based on scores dosage different inflammatory biomarkers (procalcitonin, soluble triggering receptor expressed myelloid cells type 1, C-reactive protein, mid-regional pro-adrenomedullin, pro-atrial natriuretic peptide) represent cornerstones well-established management plan by improving patient’s outcome. This review article provides an overview newly approved terminology considering nosocomial pneumonia, as well biomarkers, diagnostic new treatment options that can guide this spectrum infections.

Language: Английский

Citations

18
Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis DOI Creative Commons
Mariachiara Ippolito, Giovanni Misseri, Giulia Catalisano

et al.

Antibiotics, Journal Year: 2021, Volume and Issue: 10(5), P. 545 - 545

Published: May 7, 2021

The aim of this systematic review and meta-analysis was to estimate the pooled occurrence ventilator-associated pneumonia (VAP) among patients admitted an intensive care unit with COVID-19 mortality those who developed VAP. We performed a search on PubMed, EMBASE Web Science from inception 2nd March 2021 for nonrandomized studies specifically addressing VAP in adult reporting data at least one primary outcome interest. Random effect single-arm (at longest follow up) ICU length stay. Twenty were included meta-analysis, total 2611 episode estimated 45.4% (95% C.I. 37.8–53.2%; 2611/5593 patients; I2 = 96%). 42.7% 34–51.7%; 371/946 82%). summary metric mean LOS 28.58 days 21.4–35.8; 98%). Sensitivity analysis showed that may have higher risk developing than without (OR 3.24; 95% 2.2–4.7; P 0.015; 67.7%; five comparison group).

Language: Английский

Citations

90
Predictors and microbiology of respiratory and bloodstream bacterial infection in patients with COVID-19: living rapid review update and meta-regression DOI Creative Commons
Bradley J. Langford, Miranda So, Valerie Leung

et al.

Clinical Microbiology and Infection, Journal Year: 2021, Volume and Issue: 28(4), P. 491 - 501

Published: Nov. 26, 2021

Language: Английский

Citations

69
Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients DOI
Jacopo Fumagalli, Mauro Panigada, Michael Klompas

et al.

Current Opinion in Critical Care, Journal Year: 2021, Volume and Issue: 28(1), P. 74 - 82

Published: Nov. 24, 2021

We conducted a systematic literature review to summarize the available evidence regarding incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because acute respiratory distress syndrome secondary SARS-CoV-2 infection (C-ARDS).Sixteen studies (6484 patients) were identified. Bacterial coinfection was uncommon at baseline (<15%) but high proportion developed positive bacterial cultures thereafter leading VAP diagnosis (range 21-64%, weighted average 50%). Diagnostic criteria varied between most signs have substantial overlap with C-ARDS making it difficult differentiate colonization versus superinfection. Most episodes associated Gram-negative bacteria. Occasional cases also attributed herpes virus reactivations pulmonary aspergillosis. Potential factors driving incidence rates include immunoparalysis, prolonged ventilation, exposure immunosuppressants, understaffing, lapses prevention processes, overdiagnosis.Covid-19 who require for ARDS (>50%) developing VAP, commonly Further work is needed elucidate disease-specific strategies prevention, how best

Language: Английский

Citations

63
Attributable Mortality of Ventilator-associated Pneumonia Among Patients with COVID-19 DOI Creative Commons
Charles‐Hervé Vacheron, Alain Lepape, Anne Savey

et al.

American Journal of Respiratory and Critical Care Medicine, Journal Year: 2022, Volume and Issue: 206(2), P. 161 - 169

Published: May 10, 2022

Rationale: Patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are at higher risk of ventilator-associated pneumonia (VAP) and may have an increased attributable mortality (increased or decreased death if VAP occurs in patient) fraction (proportion deaths that to exposure) VAP-related compared subjects without disease (COVID-19). Objectives: Estimation the among patients COVID-19. Methods: Using REA-REZO surveillance network, three groups adult medical ICU were computed: control group (patients admitted between 2016 2019; prepandemic patients), pandemic COVID-19 (PandeCOV+), non-COVID-19 (PandeCOV-) during 2020. The primary outcome was estimation related these patients. multistate modeling causal inference, outcomes also evaluated. Measurements Main Results: A total 64,816 included group, 7,442 PandeCOV- 1,687 PandeCOV+ group. incidence 14.2 (95% confidence interval [CI], 13.9 14.6), 18.3 CI, 17.3 19.4), 31.9 29.8 34.2) per 1,000 ventilation-days each respectively. Attributable 90 days 3.15% (95%, 2.04% 3.43%), 2.91% -0.21% 5.02%), 8.13% 3.54% 12.24%), 1.22% 0.83 1.63), 1.42% -0.11% 2.61%), 9.17% 12.24%) for control, PandeCOV-, groups, Except developing VAP, shared similar characteristics lower (hazard ratio, 0.62; 95% 0.52 0.74) than Conclusions: VAP-attributable COVID-19, more 9% overall VAP.

Language: Английский

Citations

53