Author(s):
Rouze, Anahita ; Povoa, Pedro ; Martin-Loeches, Ignacio ; Saura, Ouriel ; Maizel, Julien ; Pouly, Olivier ; Makris, Demosthenes ; Du Cheyron, Damien ; Tamion, Fabienne ; Labruyere, Marie ; Argaud, Laurent ; Lambiotte, Fabien ; Azoulay, Elie ; Nyunga, Martine ; Turpin, Matthieu ; Imouloudene, Mehdi ; Weiss, Nicolas ; Thille, Arnaud W. ; Megarbane, Bruno ; Magira, Eleni ; Ioannidou, Iliana ; Plantefeve, Gaëtan ; Galli, Flavia ; Diaz, Emili ; Dessap, Armand Mekontso ; Asfar, Pierre ; Boyer, Alexandre ; Beurton, Alexandra ; Gavaud, Ariane ; Larrat, Charlotte ; Reignier, Jean ; Pierre, Alexandre ; Vinsonneau, Christophe ; Floch, Pierre Edouard ; Ceccato, Adrian ; Artigas, Antonio ; Iellatchitch, Alexandre ; Labreuche, Julien ; Nseir, Saad ; Morales, Luis ; Brunin, Guillaume ; Sejourne, Caroline ; Thevenin, Didier ; Garot, Denis ; Pene, Frédéric ; Le Marec, Julien ; Meguerditchian, David ; Demiselle, Julien ; Coelho, Luis ; Razazi, Keyvan
Date: 2025
Persistent ID: http://hdl.handle.net/10362/181552
Origin: Repositório Institucional da UNL
Subject(s): Co-infection; COVID-19; Intensive care; SARS-CoV-2; Ventilator-associated pneumonia; Ventilator-associated tracheobronchitis; Pulmonary and Respiratory Medicine
Description
Funding Information: This study was supported in part by a grant from the French government through the\u2009\u226A\u2009Programme Investissement d\u2019Avenir\u2009\u226B\u2009(I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpretation, writing of the report, or decision to submit for publication. Publisher Copyright: © The Author(s) 2025.
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.
