https://doi.org/10.4081/monaldi.2021.1610
Comparative evaluation of ventilator-associated pneumonia in critically ill COVID- 19 and patients infected with other corona viruses: a systematic review and meta-analysis
Submitted: September 15, 2020
Accepted: August 12, 2021
Published: September 28, 2021
Accepted: August 12, 2021
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The Coronavirus disease 19 (COVID-19) pandemic is associated with an unprecedented requirement for intensive care unit (ICU) admission, invasive mechanical ventilation, and thereby significantly increasing the risk of secondary nosocomial pneumonia, ventilator-associated pneumonia (VAP). Our study aims to identify the overall incidence of VAP, common organisms associated with it, and outcome in COVID-19 patients in comparison to the non-SARS-CoV-2 infected critically ill ventilated COVID-19 patients. A comprehensive screening was conducted using major electronic databases), from January 1st 2020 to May 31st 2021, as per the PRISMA statement. In our rapid review, we included a total of 34 studies (involving 8901 cases. Overall VAP was reported in 48.15 % (95% CI 42.3%-54%) mechanically ventilated COVID-19 patients and the mortality rate was 51.4% (95% CI 42.5%-60%). COVID-19 patients had increased risk of VAP and mortality in comparison to other non-SARS-CoV-2 viral pneumonia (OR=2.33; 95%CI 1.75-3.11; I2=15%, and OR=1.46; 95%CI 1.15-1.86; I2=0% respectively). Critically ill COVID-19 patients are prone to develop VAP, which worsens the outcome.
World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. 2020. Accessed: Mar 29, 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technicalguidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727–33.
DOI: https://doi.org/10.1056/NEJMoa2001017
Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med 2020;382:2372-4.
DOI: https://doi.org/10.1056/NEJMc2005203
Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574-8.
DOI: https://doi.org/10.1001/jama.2020.5394
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
DOI: https://doi.org/10.1016/j.tmaid.2020.101623
incent J-L, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA 2020;323:1478–10.
DOI: https://doi.org/10.1001/jama.2020.2717
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVI-19-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Prevention of Ventilator-Associated Pneumonia. Critical Care Med 2018;46:181-8.
DOI: https://doi.org/10.1097/CCM.0000000000002736
Morris AC, Datta D, Shankar-Hari M, et al. Cell-surface signatures of immune dysfunction risk-stratify critically ill patients: INFECT study. Intensive Care Med 2018;44:627-35.
DOI: https://doi.org/10.1007/s00134-018-5247-0
Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol 2013;13:862-74.
DOI: https://doi.org/10.1038/nri3552
Deng Y, Liu W, Liu K, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chin Med J (Engl) 2020;133:1261-7.
DOI: https://doi.org/10.1097/CM9.0000000000000824
Wang L, He W, Yu X, H et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect 2020;80:639-45.
DOI: https://doi.org/10.1016/j.jinf.2020.03.019
Dong X, Cao Y, Lu X, et al. Eleven faces of coronavirus disease 2019. Allergy 2020;75:1699-709.
DOI: https://doi.org/10.1111/all.14289
PRISMA [Internet]. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Accessed: 18 April 2020. Available from: http://www.prisma-statement.org/
Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev 2019;10:ED000142.
DOI: https://doi.org/10.1002/14651858.ED000142
Blonz G, Kouatchet A, Chudeau N, et al. Epidemiology and microbiology of ventilator-associated pneumonia in COVID-19 patients: a multicenter retrospective study in 188 patients in an un-inundated French region. Crit Care 2021;25:72.
DOI: https://doi.org/10.1186/s13054-021-03493-w
Giacobbe DR, Battaglini D, Enrile EM, et al. Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with COVID-19: A multicenter study. J Clin Med 2021;10:555.
DOI: https://doi.org/10.3390/jcm10040555
Gragueb-Chatti I, Lopez A, Hamidi D, et al. Impact of dexamethasone on the incidence of ventilator-associated pneumonia and blood stream infections in COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective study. Ann Intensive Care 2021;11:87.
DOI: https://doi.org/10.1186/s13613-021-00876-8
Grasselli G, Scaravilli V, Mangioni D, et al. Hospital-acquired infections in critically ill patients with COVID-19. Chest 2021;160:454-65.
DOI: https://doi.org/10.1016/j.chest.2021.04.002
Tsitsiklis A, Zha B, Byrne A, et al. Impaired immune signaling and changes in the lung microbiome precede secondary bacterial pneumonia in COVID-19. medRxiv 2021;2021.03.23.21253487.
DOI: https://doi.org/10.1101/2021.03.23.21253487
Suarez-de-la-Rica A, Serrano P, De-la-Oliva R, et al. Secondary infections in mechanically ventilated patients with COVID-19: An overlooked matter? Rev Esp Quimioter 2021;34:330-6.
DOI: https://doi.org/10.37201/req/031.2021
Rouzé A, Martin-Loeches I, Povoa P, et al. Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study. Intensive Care Med 2021;47:188-98.
DOI: https://doi.org/10.1007/s00134-020-06323-9
Pickens CO, Gao CA, Cuttica M, et al. Bacterial superinfection pneumonia in SARS-CoV-2 respiratory failure. medRxiv 2021;2021.01.12.20248588.
DOI: https://doi.org/10.1101/2021.01.12.20248588
Moretti M, Van Laethem J, Minini A, et al. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother 2021;27:826-33.
DOI: https://doi.org/10.1016/j.jiac.2021.01.011
Maes M, Higginson E, Pereira-Dias J, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 2021;25:25. Erratum in Crit Care 2021;25:130.
DOI: https://doi.org/10.1186/s13054-021-03560-2
Luyt CE, Sahnoun T, Gautier M, et al. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study. Ann Intensive Care 2020;10:158.
DOI: https://doi.org/10.1186/s13613-020-00775-4
Bardi T, Pintado V, Gomez-Rojo M, et al. Nosocomial infections associated to COVID-19 in the intensive care unit: clinical characteristics and outcome. Eur J Clin Microbiol Infect Dis 2021;40:495-502.
DOI: https://doi.org/10.1007/s10096-020-04142-w
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021;47:60-73.
DOI: https://doi.org/10.1007/s00134-020-06294-x
Razazi K, Arrestier R, Haudebourg AF, et al. Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease. Crit Care 2020;24:699.
DOI: https://doi.org/10.1186/s13054-020-03417-0
Buetti N, Mazzuchelli T, Lo Priore E, et al. Early administered antibiotics do not impact mortality in critically ill patients with COVID-19. J Infect 2020;81:e148-9.
DOI: https://doi.org/10.1016/j.jinf.2020.06.004
Llitjos JF, Bredin S, Lascarrou JB, et al. Increased susceptibility to intensive care unit-acquired pneumonia in severe COVID-19 patients: a multicentre retrospective cohort study. Ann Intensive Care 2021;11:20.
DOI: https://doi.org/10.1186/s13613-021-00812-w
Gamberini L, Tonetti T, Spadaro S, et al. Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs. J Intensive Care 2020;8:80.
DOI: https://doi.org/10.1186/s40560-020-00514-8
Sharov KS. SARS-CoV-2-related pneumonia cases in pneumonia picture in Russia in March-May 2020: Secondary bacterial pneumonia and viral co-infections. J Glob Health 2020;10:020504.
DOI: https://doi.org/10.7189/jogh.10.020504
Søgaard KK, Baettig V, Osthoff M, et al. Community-acquired and hospital-acquired respiratory tract infection and bloodstream infection in patients hospitalized with COVID-19 pneumonia. J Intensive Care 2021;9:10.
DOI: https://doi.org/10.1186/s40560-021-00526-y
Garcia-Vidal C, Sanjuan G, Moreno-García E, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect 2021;27:83-8.
DOI: https://doi.org/10.1016/j.cmi.2020.07.041
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-1062. Erratum in: Lancet 2020;395:1038.
DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
Nseir S, Martin-Loeches I, Povoa P, et al. Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort. Crit Care 2021;25:177.
DOI: https://doi.org/10.1186/s13054-021-03588-4
De Pascale G, De Maio F, Carelli S, et al. Staphylococcus aureus ventilator-associated pneumonia in patients with COVID-19: clinical features and potential inference with lung dysbiosis. Crit Care 2021;25:197.
DOI: https://doi.org/10.1186/s13054-021-03623-4
Gysin M, Acevedo CT, Haldimann K, et al. Antimicrobial susceptibility patterns of respiratory Gram-negative bacterial isolates from COVID-19 patients in Switzerland. medRxiv 2021:2021.03.10.21253079.
DOI: https://doi.org/10.1101/2021.03.10.21253079
40.Buehler PK, Zinkernagel AS, Hofmaenner DA, et al. Bacterial pulmonary superinfections are associated with unfavourable outcomes in critically ill COVID-19 patients. medRxiv 2020:2020.09.10.20191882.
DOI: https://doi.org/10.2139/ssrn.3679891
Dhesi Z, Enne VI, Brealey D, et al. Organisms causing secondary pneumonias in COVID-19 patients at 5 UK ICUs as detected with the FilmArray test. medRxiv 2020:2020.06.22.20131573.
DOI: https://doi.org/10.1101/2020.06.22.20131573
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81. Erratum in: Lancet Respir Med 2020;8:e26.
DOI: https://doi.org/10.1016/S2213-2600(20)30079-5
Yap FH, Gomersall CD, Fung KS, et al. Increase in methicillin-resistant Staphylococcus aureus acquisition rate and change in pathogen pattern associated with an outbreak of severe acute respiratory syndrome. Clin Infect Dis 2004;39:511-6.
DOI: https://doi.org/10.1086/422641
44.Cai Q, Huang D, Ou P, et al. COVID-19 in a designated infectious diseases hospital outside Hubei Province, China. Allergy 2020;75:1742-52.
DOI: https://doi.org/10.1111/all.14309
Feng Y, Ling Y, Bai T, et al. COVID-19 with different severities: A multicenter study of clinical features. Am J Respir Crit Care Med 2020;201:1380-8.
DOI: https://doi.org/10.1164/rccm.202002-0445OC
Ben Abid F, El-Maki N, Alsoub H, et al. Middle East respiratory syndrome coronavirus infection profile in Qatar: An 8-year experience. IDCases. 2021;24:e01161. doi:10.1016/j.idcr.2021.e01161
DOI: https://doi.org/10.1016/j.idcr.2021.e01161
Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect 2020;81:266-75.
DOI: https://doi.org/10.1016/j.jinf.2020.05.046
Ippolito M, Misseri G, Catalisano G, et al. Ventilator-associated pneumonia in patients with COVID-19: A systematic review and meta-analysis. Antibiotics (Basel) 2021;10:545.
DOI: https://doi.org/10.3390/antibiotics10050545
Plachouras D, Lepape A, Suetens C. ECDC definitions and methods for the surveillance of healthcare-associated infections in intensive care units. Intensive Care Med 2018;44:2216-8.
DOI: https://doi.org/10.1007/s00134-018-5113-0
50.Meduri GU, Maul din GL, Wunderink RG, et al. Causes of fever and pulmonary densities in 337 patients with clinical manifestations of ventilator-associated pneumonia. Chest 1994;106:221-35.
DOI: https://doi.org/10.1378/chest.106.1.221
Chastre J, Luyt CE. Does this patient have VAP? Intensive Care Med 2016;42:1159–63.
DOI: https://doi.org/10.1007/s00134-016-4239-1
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med 2020;46:888-906.
DOI: https://doi.org/10.1007/s00134-020-05980-0
Kózka M, Sega A, Wojnar-Gruszka K, et al. Risk factors of pneumonia associated with mechanical ventilation. Int J Environ Res Public Health 2020;17:656.
DOI: https://doi.org/10.3390/ijerph17020656
Wu J, Liu J, Zhao X, et al. Clinical Characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu Province: A multicenter descriptive study. Clin Infect Dis 2020;71:706-12.
DOI: https://doi.org/10.1093/cid/ciaa199
Giamarellos-Bourboulis EJ, Netea MG, Rovina N, et al. Complex immune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe 2020;27:992-1000.e3.
DOI: https://doi.org/10.1016/j.chom.2020.04.009
Zhou Z, Ren L, Zhang L, et al. Heightened innate immune responses in the respiratory tract of COVID-19 patients. Cell Host Microbe 2020;27:883-90.e2.
DOI: https://doi.org/10.1016/j.chom.2020.04.017
Perico L, Benigni A, Remuzzi G. Should COVID-19 concern nephrologists? Why and to What extent? The emerging impasse of angiotensin blockade. Nephron 2020;23:19.
DOI: https://doi.org/10.1159/000507305
World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance. 13 March 2020. Accessed: Mar 29, 2020. Available from: https://apps.who.int/iris/handle/10665/331446
Hua F, Xie H, Worthington HV, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev 2016;25:CD008367.
DOI: https://doi.org/10.1002/14651858.CD008367.pub3
How to Cite
Jain, Shikha, Puneet Khanna, and Soumya Sarkar. 2021. “Comparative Evaluation of Ventilator-Associated Pneumonia in Critically Ill COVID- 19 and Patients Infected With Other Corona Viruses: A Systematic Review and Meta-Analysis”. Monaldi Archives for Chest Disease 92 (2). https://doi.org/10.4081/monaldi.2021.1610.
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