新型冠状病毒肺炎（COVID-19）或流感重症患者中呼吸机相关性肺炎（VAP）的死亡率、发病率及微生物学记录
Mortality, incidence, and microbiological documentation of ventilated acquired pneumonia (VAP) in critically ill patients with COVID-19 or influenza.
作者信息
Laurichesse Guillaume, Schwebel Carole, Buetti Niccolò, Neuville Mathilde, Siami Shidasp, Cohen Yves, Laurent Virginie, Mourvillier Bruno, Reignier Jean, Goldgran-Toledano Dany, Ruckly Stéphane, de Montmollin Etienne, Souweine Bertrand, Timsit Jean-François, Dupuis Claire
机构信息
Pneumology and infectious diseases Gabriel montpied hospital, Clermont Ferrand University Hospital, 63000, Clermont Ferrand, France.
Medical Intensive Care Unit, University Hospital, Grenoble-Alpes, 38000, Grenoble, France.
出版信息
Ann Intensive Care. 2023 Oct 30;13(1):108. doi: 10.1186/s13613-023-01207-9.
BACKGROUND
Data on ventilator associated pneumonia (VAP) in COVID-19 and influenza patients admitted to intensive care units (ICU) are scarce. This study aimed to estimate day-60 mortality related to VAP in ICU patients ventilated for at least 48 h, either for COVID-19 or for influenza, and to describe the epidemiological characteristics in each group of VAP.
DESIGN
Multicentre retrospective observational study.
SETTING
Eleven ICUs of the French OutcomeRea network.
PATIENTS
Patients treated with invasive mechanical ventilation (IMV) for at least 48 h for either COVID-19 or for flu.
RESULTS
Of the 585 patients included, 503 had COVID-19 and 82 had influenza between January 2008 and June 2021. A total of 232 patients, 209 (41.6%) with COVID-19 and 23 (28%) with influenza, developed 375 VAP episodes. Among the COVID-19 and flu patients, VAP incidences for the first VAP episode were, respectively, 99.2 and 56.4 per 1000 IMV days (p < 0.01), and incidences for all VAP episodes were 32.8 and 17.8 per 1000 IMV days (p < 0.01). Microorganisms of VAP were Gram-positive cocci in 29.6% and 23.5% of episodes of VAP (p < 0.01), respectively, including Staphylococcus aureus in 19.9% and 11.8% (p = 0.25), and Gram-negative bacilli in 84.2% and 79.4% (p = 0.47). In the overall cohort, VAP was associated with an increased risk of day-60 mortality (aHR = 1.77 [1.36; 2.30], p < 0.01), and COVID-19 had a higher mortality risk than influenza (aHR = 2.22 [CI 95%, 1.34; 3.66], p < 0.01). VAP was associated with increased day-60 mortality among COVID-19 patients (aHR = 1.75 [CI 95%, 1.32; 2.33], p < 0.01), but not among influenza patients (aHR = 1.75 [CI 95%, 0.48; 6.33], p = 0.35).
CONCLUSION
The incidence of VAP was higher in patients ventilated for at least 48 h for COVID-19 than for influenza. In both groups, Gram-negative bacilli were the most frequently detected microorganisms. In patients ventilated for either COVID-19 or influenza VAP and COVID-19 were associated with a higher risk of mortality.
背景
关于入住重症监护病房（ICU）的新冠肺炎和流感患者发生呼吸机相关性肺炎（VAP）的数据稀缺。本研究旨在评估因新冠肺炎或流感接受至少48小时机械通气的ICU患者中与VAP相关的60天死亡率，并描述每组VAP的流行病学特征。
设计
多中心回顾性观察研究。
地点
法国OutcomeRea网络的11个ICU。
患者
因新冠肺炎或流感接受有创机械通气（IMV）至少48小时的患者。
结果
在2008年1月至2021年6月纳入的585例患者中，503例患有新冠肺炎，82例患有流感。共有232例患者发生了375次VAP发作，其中209例（41.6%）新冠肺炎患者和23例（28%）流感患者。在新冠肺炎和流感患者中，首次VAP发作的发生率分别为每1000个IMV日99.2次和56.4次（p<0.01），所有VAP发作的发生率分别为每1000个IMV日32.8次和17.8次（p<0.01）。VAP的微生物分别在29.6%和23.5%的VAP发作中为革兰氏阳性球菌（p<0.01），其中金黄色葡萄球菌分别占19.9%和11.8%（p=0.25），革兰氏阴性杆菌分别占84.2%和79.4%（p=0.47）。在整个队列中，VAP与60天死亡率增加相关（校正风险比[aHR]=1.77[1.36；2.30]，p<0.01），且新冠肺炎的死亡风险高于流感（aHR=2.22[95%置信区间，1.34；3.66]，p<0.01）。VAP与新冠肺炎患者60天死亡率增加相关（aHR=1.75[95%置信区间，1.32；2.33]，p<0.01），但与流感患者无关（aHR=1.75[95%置信区间，0.48；6.33]，p=0.35）。
结论
因新冠肺炎接受至少48小时机械通气的患者中VAP的发生率高于流感患者。在两组中，革兰氏阴性杆菌是最常检测到的微生物。对于因新冠肺炎或流感接受机械通气的患者，VAP和新冠肺炎均与较高的死亡风险相关。
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