AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, 94010, Créteil, France.
Crit Care. 2020 Dec 18;24(1):699. doi: 10.1186/s13054-020-03417-0.
Data on incidence of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with severe SARS-CoV-2 infection are limited.
We conducted a monocenter retrospective study comparing the incidence of VAP and invasive aspergillosis between patients with COVID-19-related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS).
We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 h. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p < 0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS: 58 (64%) vs. 36 (44%), p = 0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p < 0.01]. The incidence of multi-drug-resistant bacteria (MDR)-related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p = 0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p < 0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p = 0.003], but there was no difference in Aspergillus colonization.
In our experience, we evidenced a higher incidence of VAP and MDR-VAP in C-ARDS than in NC-ARDS and a lower risk for invasive aspergillosis in the former group.
关于严重 SARS-CoV-2 感染患者呼吸机相关性肺炎（VAP）和侵袭性肺曲霉病的发病率数据有限。
我们进行了一项单中心回顾性研究，比较了 COVID-19 相关急性呼吸窘迫综合征（C-ARDS）患者和非 SARS-CoV-2 病毒性 ARDS（NC-ARDS）患者的 VAP 和侵袭性曲霉病发病率。
我们评估了 90 例 C-ARDS 和 82 例 NC-ARDS 患者，这些患者均接受了超过 48 小时的机械通气。在 ICU 入院时，C-ARDS 中细菌合并感染的比例明显低于 NC-ARDS：14 例（16%）比 38 例（48%），p<0.01。相反，C-ARDS 中发生至少一次 VAP 发作的患者比例明显高于 NC-ARDS：58 例（64%）比 36 例（44%），p=0.007。在调整死亡和呼吸机脱机后，C-ARDS 发生 VAP 的概率显著更高[亚危险比=1.72（1.14-2.52），p<0.01]。C-ARDS 中与多重耐药菌（MDR）相关的 VAP 发生率明显高于 NC-ARDS：21 例（23%）比 9 例（11%），p=0.03。C-ARDS 中碳青霉烯类药物的使用比例明显高于 NC-ARDS：48 例（53%）比 21 例（26%），p<0.01。根据 AspICU 算法，C-ARDS 中疑似曲霉病的病例数明显少于 NC-ARDS [2 例（2%）比 12 例（15%），p=0.003]，但曲霉定植无差异。
根据我们的经验，C-ARDS 中 VAP 和 MDR-VAP 的发生率高于 NC-ARDS，而前者侵袭性曲霉病的风险较低。
Zotero 插件