Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19 : a multinational, multicentre study, prospective, observational study
Reyes, Luis Felipe (University of Oxford)
Rodríguez, Alejandro (Hospital Universitari Joan XXIII de Tarragona)
Fuentes, Yuli V. (Clinica Universidad de La Sabana)
Duque, Sara (Universidad de La Sabana)
García-Gallo, Esteban (Universidad de La Sabana)
Bastidas, Alirio (Universidad de La Sabana)
Serrano-Mayorga, Cristian C. (Clinica Universidad de La Sabana)
Ibáñez-Prada, Elsa D. (Universidad de La Sabana)
Moreno, Gerard (Hospital Universitari Joan XXIII de Tarragona)
Ramirez-Valbuena, Paula C. (Universidad de La Sabana)
Ospina-Tascon, Gustavo (Fundación Valle del Lili)
Hernandez, Glenn (Pontificia Universidad Católica de Chile)
Silva, Edwin (Fundación Clínica Shaio)
Díaz, Ana Maria (Eugenio Espejo Hospital of Specialties)
Jibaja, Manuel (Eugenio Espejo Hospital of Specialties)
Vera-Alarcon, Magdalena (Pontificia Universidad Católica de Chile)
Díaz Santos, Emilio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Bodí, María (Hospital Universitari Joan XXIII de Tarragona)
Solé-Violán, Jordi (Universidad Fernando Pessoa Canarias)
Ferrer, Ricard (Hospital Universitari Vall d'Hebron)
Albaya-Moreno, Antonio (Guadalajara University Hospital)
Socias, Lorenzo (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Figueroa, William (Universidad de La Sabana)
Lozano-Villanueva, Jose L. (Fundación Clínica Shaio)
Varón-Vega, Fabio (La Cardio)
Estella, Ángel (Jerez University Hospital)
Loza-Vazquez, Ana (Hospital Universitario Virgen de Valme (Sevilla, Andalusia))
Jorge García, Ruth Noemí (Hospital Providencial Nuestra Señora de Gracia)
Sancho, Isabel (Hospital Universitario Miguel Servet (Saragossa))
Shankar-Hari, Manu (The University of Edinburgh)
Martin-Loeches, Ignacio (St. James's Hospital (Dublín, Irlanda))
Universitat Autònoma de Barcelona

Fecha:	2023
Resumen:	Around one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28. 8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18. 6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10. 3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21. 2% [266/1252]), followed by Klebsiella pneumoniae (19. 1% [239/1252]) and Staphylococcus aureus (15. 5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1. 81 [1. 40-2. 34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1. 34 [0. 98-1. 83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes. Trial registration: This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Medical research ; Virology
Publicado en:	Scientific reports, Vol. 13 (april 2023) , ISSN 2045-2322

DOI: 10.1038/s41598-023-32265-5
PMID: 37085552

15 p, 3.0 MB

El registro aparece en las colecciones:
Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Instituto de Investigación e Innovación Parc Taulí (I3PT)
Artículos > Artículos de investigación
Artículos > Artículos publicados