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Background <p>The management of severe SARS-CoV-2 pneumonia, alongside logistical constraints, evolved between the first and subsequent COVID-19 waves. This study aimed to compare the prevalence of early bacterial pulmonary co-infections and the incidence of ventilator-associated lower respiratory tract infections (VA-LRTI) across the first and second waves of the pandemic, and to characterize their microbiology.</p> Methods <p>Latter part of a multicenter retrospective European cohort analysis conducted in 35 ICUs. Adult patients admitted for SARS-CoV-2 pneumonia and requiring invasive mechanical ventilation ≥ 48&#xa0;h were consecutively included from both waves (February-May 2020 for period 1, October 2020-April 2021 for period 2). Co-infections were defined by bacterial isolation in respiratory secretions or blood cultures, or a positive pneumococcal urinary antigen test, within 48&#xa0;h after intubation. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. The 28-day cumulative incidence of first VA-LRTI episodes was estimated using the Kalbfleisch and Prentice method, with co-infection prevalence and VA-LRTI incidence compared using multivariable logistic regression and Fine-and-Gray models, respectively.</p> Results <p>The study included 1,154 patients (558 in period 1 and 596 in period 2). Co-infection prevalence significantly rose from 9.7% in period 1 to 14.9% in period 2 (adjusted odds ratio (95% confidence interval) 1.52 (1.04–2.22), <i>p</i> = 0.03). Gram-positive cocci dropped from 59 to 48% of co-infections between periods 1 and 2. The overall incidence of VA-LRTI was similar across periods (50.4% and 53.9%, adjusted sub distribution hazard ratio (sHR) 1.14 (0.96–1.35), <i>p</i> = 0.11), with a significant increase in VAP incidence in period 2 (36% to 44.8%, adjusted sHR 1.37 (1.12–1.66), <i>p</i> = 0.001), predominantly occurring within the initial 14&#xa0;days after intubation, and a concurrent significant decrease in VAT incidence (14.3% to 9.1%, adjusted sHR 0.61 (0.42–0.88), <i>p</i> = 0.007). Gram-negative bacilli, led by <i>Pseudomonas aeruginosa</i>, Enterobacter spp., and Klebsiella spp., were responsible for 89% and 84% of VA-LRTI in periods 1 and 2, respectively.</p> Conclusions <p>Between the first and second COVID-19 waves, the prevalence of early bacterial pulmonary co-infections significantly increased among intubated patients. Although the overall incidence of VA-LRTI remained stable, there was a significant shift from VAT to VAP episodes.</p>

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Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study

  • 期刊论文

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  • 发表日期：

    2025年3月5日

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  • Anahita Rouze,
  • Pedro Povoa,
  • Ignacio Martin-Loeches,
  • Ouriel Saura,
  • Julien Maizel,
  • Olivier Pouly,
  • Demosthenes Makris,
  • Damien Du Cheyron,
  • Fabienne Tamion,
  • Marie Labruyere,
  • Laurent Argaud,
  • Fabien Lambiotte,
  • Elie Azoulay,
  • Martine Nyunga,
  • Matthieu Turpin,
  • Mehdi Imouloudene,
  • Nicolas Weiss,
  • Arnaud W. Thille,
  • Bruno Megarbane,
  • Eleni Magira,
  • Iliana Ioannidou,
  • Gaëtan Plantefeve,
  • Flavia Galli,
  • Emili Diaz,
  • Armand Mekontso Dessap,
  • Pierre Asfar,
  • Alexandre Boyer,
  • Alexandra Beurton,
  • Ariane Gavaud,
  • Charlotte Larrat,
  • Jean Reignier,
  • Alexandre Pierre,
  • Christophe Vinsonneau,
  • Pierre-Edouard Floch,
  • Adrian Ceccato,
  • Antonio Artigas,
  • Alexandre Iellatchitch,
  • Julien Labreuche,
  • Saad Nseir,
  • Julien Poissy,
  • Raphaël Favory,
  • Sébastien Preau,
  • Mercè Jourdain,
  • Luis Coelho,
  • Sean Boyd,
  • Charles-Edouard Luyt,
  • Matthieu Metzelard,
  • Thierry Van der Linden,
  • Vassiliki Tsolaki,
  • Pierre Cuchet,
  • Zoé Demailly,
  • Jean-Pierre Quenot,
  • Louis Kreitmann,
  • Wafa Zarrougui,
  • Anastasia Saade,
  • Guillaume Voiriot,
  • Claire Boulle Geronimi,
  • Loïc Le Guennec,
  • Justine Bardin,
  • Sebastian Voicu,
  • Damien Contou,
  • Antoni Torres,
  • Gemma Goma,
  • Keyvan Razazi,
  • Julien Demiselle,
  • David Meguerditchian,
  • Julien Le Marec,
  • Frédéric Pene,
  • Denis Garot,
  • Didier Thevenin,
  • Caroline Sejourne,
  • Guillaume Brunin,
  • Luis Morales

摘要

Background

The management of severe SARS-CoV-2 pneumonia, alongside logistical constraints, evolved between the first and subsequent COVID-19 waves. This study aimed to compare the prevalence of early bacterial pulmonary co-infections and the incidence of ventilator-associated lower respiratory tract infections (VA-LRTI) across the first and second waves of the pandemic, and to characterize their microbiology.

Methods

Latter part of a multicenter retrospective European cohort analysis conducted in 35 ICUs. Adult patients admitted for SARS-CoV-2 pneumonia and requiring invasive mechanical ventilation ≥ 48 h were consecutively included from both waves (February-May 2020 for period 1, October 2020-April 2021 for period 2). Co-infections were defined by bacterial isolation in respiratory secretions or blood cultures, or a positive pneumococcal urinary antigen test, within 48 h after intubation. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. The 28-day cumulative incidence of first VA-LRTI episodes was estimated using the Kalbfleisch and Prentice method, with co-infection prevalence and VA-LRTI incidence compared using multivariable logistic regression and Fine-and-Gray models, respectively.

Results

The study included 1,154 patients (558 in period 1 and 596 in period 2). Co-infection prevalence significantly rose from 9.7% in period 1 to 14.9% in period 2 (adjusted odds ratio (95% confidence interval) 1.52 (1.04–2.22), p = 0.03). Gram-positive cocci dropped from 59 to 48% of co-infections between periods 1 and 2. The overall incidence of VA-LRTI was similar across periods (50.4% and 53.9%, adjusted sub distribution hazard ratio (sHR) 1.14 (0.96–1.35), p = 0.11), with a significant increase in VAP incidence in period 2 (36% to 44.8%, adjusted sHR 1.37 (1.12–1.66), p = 0.001), predominantly occurring within the initial 14 days after intubation, and a concurrent significant decrease in VAT incidence (14.3% to 9.1%, adjusted sHR 0.61 (0.42–0.88), p = 0.007). Gram-negative bacilli, led by Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp., were responsible for 89% and 84% of VA-LRTI in periods 1 and 2, respectively.

Conclusions

Between the first and second COVID-19 waves, the prevalence of early bacterial pulmonary co-infections significantly increased among intubated patients. Although the overall incidence of VA-LRTI remained stable, there was a significant shift from VAT to VAP episodes.