Attributable Mortality of Ventilator-associated Pneumonia Among Patients with COVID-19

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

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Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study

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

Published: Jan. 7, 2022

Abstract Background In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in treated high-flow nasal oxygen (HFNO). However, effects of different exposure times on clinical outcomes remain unclear. We evaluated effect AW-PP risk endotracheal and in-hospital mortality ARF HFNO analyzed to AW-PP. Methods This multicenter prospective cohort study six ICUs 6 centers Argentine consecutively included > 18 years age confirmed requiring from June 2020 January 2021. primary analysis, main was at least h/day, compared non-prone (NON-PP). sensitivity based number hours receiving Inverse probability weighting–propensity score (IPW-PS) used adjust conditional treatment assignment. The outcome (ETI); secondary hospital mortality. Results During period, 580 were screened 335 included; 187 (56%) tolerated [median (p25–75)] 12 (9–16) h/day 148 (44%) served as controls. IPW–propensity analysis showed standardized differences < 0.1 all variables assessed. After adjusting other confounders, OR (95% CI) ETI group 0.36 (0.2–0.7), a progressive reduction increased. adjusted ≥ 0.47 (0.19–1.31). 8 h/d resulted further [0.37 (0.17–0.8)]. Conclusion population, reduced intubation,

Language: Английский

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Clostridioides difficile infection (CDI) during the COVID-19 pandemic

Anaerobe, Journal Year: 2022, Volume and Issue: 74, P. 102518 - 102518

Published: Jan. 19, 2022

Language: Английский

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Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation

Journal of Infection, Journal Year: 2022, Volume and Issue: 85(1), P. 57 - 63

Published: May 21, 2022

To determine the incidence and characteristics of superinfections in mechanically ventilated COVID-19 patients, impact dexamethasone as standard therapy.This multicentre, observational, retrospective study included patients ≥ 18 years admitted from March 1st 2020 to January 31st 2021 with infection who received mechanical ventilation. Patient characteristics, clinical therapy survival were examined.155/156 (115 men, mean age 62 years, range 26-84 years) included. 67 (43%) had 90 superinfections, pneumonia dominated (78%). Superinfections associated receiving (66% vs 32%, p<0.0001), autoimmune disease (18% 5.7%, p<0.016) longer ICU stays (26 17 days, p<0,001). Invasive fungal infections reported exclusively dexamethasone-treated [8/67 (12%) 0/88 (0%), p<0.0001]. Unadjusted 90-day did not differ between or without (64% 73%, p=0.25), but was lower versus (58% 78%, p=0.007). In multiple regression analysis, superinfection use [OR 3.7 (1.80-7.61), p<0.001], pre-existing 3.82 (1.13-12.9), p=0.031] length stay 1.05 p<0.001].In critically ill care strongly independently superinfections.

Language: Английский

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Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set

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

Published: Aug. 3, 2022

The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and conditions; however, data have suggested that patterns of these differ between other pneumonitides. This secondary analysis aimed explore co-infection intensive unit-acquired infections (ICU-AI) the relationship use corticosteroids in large, international cohort critically ill patients.

Language: Английский

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Impact of the COVID-19 Pandemic on the Clinical Profile of Candidemia and the Incidence of Fungemia Due to Fluconazole-Resistant Candida parapsilosis

Journal of Fungi, Journal Year: 2022, Volume and Issue: 8(5), P. 451 - 451

Published: April 27, 2022

Severely ill COVID-19 patients are at high risk of nosocomial infections. The aim the study was to describe characteristics candidemia during pre-pandemic period (January 2019−February 2020) compared pandemic (March 2020−September 2021). Antifungal susceptibilities were assessed using EUCAST E.Def 7.3.2 broth dilution method. Fluconazole-resistant C. parapsilosis isolates (FRCP) studied for sequencing ERG11 gene. incidence and bloodstream infection increased significantly in (p = 0.021). ICU admission, mechanical ventilation, parenteral nutrition corticosteroids administration more frequent with who had been admitted due COVID-19. Fifteen cases FRCP fungemia detected. first case recorded 10 months before a patient transferred from another hospital. 1.34 0.16 all other < 0.001). previous Candida spp. colonization, arterial catheter use, renal function replacement therapy FRCP. All showed Y132F mutation. In conclusion, experienced an increase

Language: Английский

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Changing Epidemiology of Respiratory Tract Infection during COVID-19 Pandemic

Antibiotics, Journal Year: 2022, Volume and Issue: 11(3), P. 315 - 315

Published: Feb. 25, 2022

The outbreak of COVID-19 has significantly changed the epidemiology respiratory tract infection in several ways. implementation non-pharmaceutical interventions (NPIs) including universal masking, hand hygiene, and social distancing not only resulted a decline reported SARS-CoV-2 cases but also contributed to non-COVID-19 infection-related hospital utilization. Moreover, it led decreased incidence previous commonly encountered pathogens, such as influenza Streptococcus pneumoniae. Although antimicrobial agents are essential for treating patients with co-infection, prescribing antibiotics was higher than estimated prevalence bacterial which indicated overuse or unnecessary antibiotic use during pandemic. Furthermore, inappropriate exposure may drive selection drug-resistant microorganisms, disruption control setting measures result spread multidrug-resistant organisms (MDROs). In conclusion, NPIs could be effective preventing changing microbiologic distribution pathogens; however, we should continue epidemiological surveillance establish updated information, stewardship programs appropriate antibiotic, prevention prevent MDROs

Language: Английский

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Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study

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

Published: Oct. 18, 2022

Abstract Background The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 non-COVID-19 critically ill patients. Methods We used data from Eurobact II study, a prospective observational multicontinental cohort on HABSI treated in ICU. For current analysis, we selected centers that included both performed descriptive statistics terms patients’ characteristics, source infection microorganism distribution. studied association status mortality using multivariable fragility Cox models. Results A total 53 19 countries over 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) for HABSI. Included comprised 252 (30.4%) 577 (69.6%) time interval hospital admission was similar groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) primary (25.4% 17.2%, 0.006) more frequent had often enterococcal (20.5% 9%) Acinetobacter spp. (18.8% 13.6%) HABSIs. Bacteremic an increased hazard ratio (HR) versus (HR 1.91, 95% CI 1.49–2.45). Conclusions showed differed Enterococcal predominated with elevated risk mortality. Trial registration ClinicalTrials.org number NCT03937245 . Registered 3 May 2019.

Language: Английский

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Antimicrobial Resistance in Ventilator-Associated Pneumonia: Predictive Microbiology and Evidence-Based Therapy

Infectious Diseases and Therapy, Journal Year: 2023, Volume and Issue: 12(6), P. 1527 - 1552

Published: June 1, 2023

Ventilator-associated pneumonia (VAP) is a serious intensive care unit (ICU)-related infection in mechanically ventilated patients that frequent, as more than half of antibiotics prescriptions ICU are due to VAP. Various risk factors and diagnostic criteria for VAP have been referred different settings. The estimated attributable mortality can go up 50%, which higher cases antimicrobial-resistant When the diagnosis patient made, initiation effective antimicrobial therapy must be prompt. Microbiological required optimize timely since early treatment fundamental better outcomes, with controversy continuing regarding optimal sampling testing. Understanding role resistance context crucial era continuously evolving clones represent an urgent threat global health. This review focused on adult its novel microbiological tools. It aims summarize current evidence-based knowledge about mechanisms caused by multidrug-resistant bacteria clinical settings focus Gram-negative pathogens. highlights management prevention drug-resistant also addresses emerging concepts related predictive microbiology sheds lights coronavirus disease 2019 (COVID-19).

Language: Английский

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Impact of Multidrug-Resistant Bacteria in a Cohort of COVID-19 Critically Ill Patients: Data from a Prospective Observational Study Conducted in a High-Antimicrobial-Resistance-Prevalence Center

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(2), P. 410 - 410

Published: Jan. 10, 2025

Background: Bacterial superinfections are common complications during viral infections, but the impact of multidrug-resistant (MDR) pathogens in critically ill patients affected by coronavirus disease 2019 (COVID-19) is still debated. Methods: This an observational, monocentric, and prospective study designed to investigate incidence, risk factors, outcomes MDR bacterial COVID-19 admitted intensive care unit (ICU). Results: A high incidence (66%, 159/241) was observed: ventilator-associated pneumonia (VAP) (65%, 104/159) bloodstream infection (BSI, 32%, 51/159) were most common. Superinfections, Extra-Corporeal Membrane Oxygenation (ECMO) support, prone positioning increased death five, four, more-than-two times, respectively (OR = 5.431, IC 95%: 1.637-18.014; 4.462, 1.616-12.324 2.346, 1.127-4.883). bacteria identified 61% with superinfection, a cumulative 37.2% at day 14. Carbapenem-resistant Acinetobacter baumannii (CR-AB) CR-Klebsiella pneumoniae (CR-KP) causative agents (24.3% 13.7%). CR-AB found significantly increase both ICU in-hospital mortality (76.4% 78.2%), whereas CR-KP had no direct on mortality. Prior rectal colonization (p < 0.0001), mechanical ventilation 0.0017), prolonged stay use iNO 0.0082), vasopressors 0.0025), curarization 0.0004), 0.0084) be factors for CR-AB. Conclusions: Critically developing superinfection. While mortality, appeared

Language: Английский

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