Hraiech S, Ladjal K, Guervilly C, Hyvernat H, Papazian L, Forel J M, Lopez A, Peres N, Dellamonica J, Leone M, Gragueb-Chatti I
Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France.
Faculté de Médecine, Aix-Marseille Université, Centre d'Etudes Et de Recherches Sur Les Services de Santé Et Qualité de Vie EA 3279, 13005, Marseille, France.
Crit Care. 2023 Oct 4;27(1):385. doi: 10.1186/s13054-023-04660-x.
Patients undergoing mechanical ventilation (MV) for COVID-19 exhibit an increased risk of ventilator-associated pneumonia (VAP). The occurrence of lung abscesses following VAP in these patients has been poorly studied. We aimed to describe the incidence, characteristics, risk factors and prognosis of lung abscesses complicating VAP after COVID-19.
We conducted an observational, retrospective study in three French intensive care units. Patients admitted for acute respiratory failure with a confirmed SARS-CoV-2 PCR and requiring MV for more than 48 h were included.
Among the 507 patients included, 326 (64%) had a documented VAP. Of these, 23 (7%) developed a lung abscess. Enterobacterales (15/23, 65%) were the main documentation, followed by non-fermenting Gram-negative bacilli (10/23, 43%) and Gram-positive cocci (8/23, 35%). Lung abscesses were mainly plurimicrobial (15/23, 65%). In multivariate analysis, a plurimicrobial 1st VAP episode (OR (95% CI) 2.93 (1.16-7.51); p = 0.02) and the use of hydrocortisone (OR (95% CI) 4.86 (1.95-12.1); p = 0.001) were associated with lung abscess development. Intensive care unit (ICU) mortality of patients with lung abscesses reached 52%, but was not significantly higher than for patients with VAP but no lung abscess. Patients with lung abscesses had reduced ventilator-free days at day 60, a longer duration of MV and ICU stay than patients with VAP but no lung abscess (respectively, 0 (0-3) vs. 16 (0-42) days; p < 0.001, 49 (32-73) vs. 25 (11-41) days; p < 0.001, 52 (36-77) vs. 28 (16-47) days; p < 0.001).
Lung abscessing pneumonia is not uncommon among COVID-19 patients developing VAP. A plurimicrobial first VAP episode and the use of hydrocortisone are independently associated with this complication. In COVID-19 patients with persistent VAP, a chest CT scan investigating the evolution toward lung abscess should be considered.
因新型冠状病毒肺炎（COVID-19）接受机械通气（MV）的患者发生呼吸机相关性肺炎（VAP）的风险增加。这些患者VAP后发生肺脓肿的情况研究较少。我们旨在描述COVID-19后并发VAP的肺脓肿的发生率、特征、危险因素和预后。
我们在法国的三个重症监护病房进行了一项观察性回顾性研究。纳入因急性呼吸衰竭入院且严重急性呼吸综合征冠状病毒2（SARS-CoV-2）PCR确诊并需要MV超过48小时的患者。
在纳入的507例患者中，326例（64%）记录有VAP。其中，23例（7%）发生了肺脓肿。肠杆菌科细菌（15/23，65%）是主要病原体，其次是非发酵革兰氏阴性杆菌（10/23，43%）和革兰氏阳性球菌（8/23，35%）。肺脓肿主要为多微生物感染（15/23，65%）。多因素分析显示，多微生物首次VAP发作（比值比（OR）（95%置信区间）2.93（1.16 - 7.51）；p = 0.02）和氢化可的松的使用（OR（95%置信区间）4.86（1.95 - 12.1）；p = 0.001）与肺脓肿的发生相关。肺脓肿患者的重症监护病房（ICU）死亡率达52%，但并不显著高于发生VAP但无肺脓肿的患者。与发生VAP但无肺脓肿的患者相比，肺脓肿患者在第60天时无呼吸机天数减少，MV持续时间和ICU住院时间更长（分别为0（0 - 3）天对16（0 - 42）天；p < 0.001，49（32 - 73）天对25（11 - 41）天；p < 0.001，52（36 - 77）天对28（16 - 47）天；p < 0.001）。
肺脓肿性肺炎在发生VAP的COVID-19患者中并不少见。多微生物首次VAP发作和氢化可的松的使用与这一并发症独立相关。对于COVID-19中持续存在VAP的患者，应考虑进行胸部CT扫描以调查是否进展为肺脓肿。
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