COVID-19 患者呼吸机相关性肺炎的流行病学和微生物学：在法国未受灾地区的 188 例患者中进行的一项多中心回顾性研究。
Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: a multicenter retrospective study in 188 patients in an un-inundated French region.
机构信息
Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendee, Les Oudairies, 85000, La Roche-Sur-Yon, France.
Medical Intensive Care Unit, University Hospital of Angers, 4 rue Larrey 49933, Angers, France.
出版信息
Crit Care. 2021 Feb 18;25(1):72. doi: 10.1186/s13054-021-03493-w.
BACKGROUND
The COVID-19 pandemic is responsible for many hospitalizations in intensive care units (ICU), with widespread use of invasive mechanical ventilation (IMV) which exposes patients to the risk of ventilator-associated pneumonia (VAP). The characteristics of VAP in COVID-19 patients remain unclear.
METHODS
We retrospectively collected data on all patients hospitalized for COVID-19 during the first phase of the epidemic in one of the seven ICUs of the Pays-de-Loire region (North-West France) and who were on invasive mechanical ventilation for more than 48 h. We studied the characteristics of VAP in these patients. VAP was diagnosed based on official recommendations, and we included only cases of VAP that were confirmed by a quantitative microbiological culture.
FINDINGS
We analyzed data from 188 patients. Of these patients, 48.9% had VAP and 19.7% experienced multiple episodes. Our study showed an incidence of 39.0 VAP per 1000 days of IMV (until the first VAP episode) and an incidence of 33.7 VAP per 1000 days of IMV (including all 141 episodes of VAP). Multi-microbial VAP accounted for 39.0% of all VAP, and 205 pathogens were identified. Enterobacteria accounted for 49.8% of all the isolated pathogens. Bacteremia was associated in 15 (10.6%) cases of VAP. Pneumonia was complicated by thoracic empyema in five cases (3.5%) and by pulmonary abscess in two cases (1.4%). Males were associated with a higher risk of VAP (sHR 2.24 CI95% [1.18; 4.26] p = 0.013).
INTERPRETATION
Our study showed an unusually high incidence of VAP in patients admitted to the ICU for severe COVID-19, even though our services were not inundated during the first wave of the epidemic. We also noted a significant proportion of enterobacteria. VAP-associated complications (abscess, empyema) were not exceptional.
REGISTRATION
As an observational study, this study has not been registered.
背景
COVID-19 大流行导致许多患者住院接受重症监护治疗（ICU），广泛应用有创机械通气（IMV）会使患者面临呼吸机相关性肺炎（VAP）的风险。COVID-19 患者的 VAP 特征尚不清楚。
方法
我们回顾性收集了在法国西北部卢瓦尔河地区（Pays-de-Loire）七个 ICU 中，COVID-19 患者在第一波疫情期间因 COVID-19 住院并接受超过 48 小时有创机械通气的所有患者的数据。我们研究了这些患者的 VAP 特征。VAP 根据官方建议进行诊断，并且仅包括经定量微生物培养证实的 VAP 病例。
结果
我们分析了 188 例患者的数据。其中，48.9%的患者发生了 VAP，19.7%的患者发生了多次 VAP。我们的研究显示，每 1000 天 IMV 发生 39.0 例 VAP（直到发生首例 VAP ）和每 1000 天 IMV 发生 33.7 例 VAP（包括所有 141 例 VAP）。多重微生物 VAP 占所有 VAP 的 39.0%，共鉴定出 205 种病原体。肠杆菌科占所有分离病原体的 49.8%。15 例（10.6%）VAP 合并菌血症。5 例（3.5%）肺炎并发脓胸，2 例（1.4%）并发肺脓肿。男性发生 VAP 的风险更高（校正危险比 2.24，95%CI95%[1.18; 4.26]，p=0.013）。
结论
我们的研究显示，在因严重 COVID-19 住院接受 ICU 治疗的患者中，VAP 的发生率异常高，尽管我们的服务在第一波疫情中并未泛滥。我们还注意到肠杆菌科的比例很大。VAP 相关并发症（脓肿、脓胸）并不罕见。
注册
作为一项观察性研究，本研究未进行注册。
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