Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study.
Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: a retrospective cohort study.
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DOI：
10.1186/s13613-020-00775-4
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发表时间：
2020-11-23
影响因子：
8.1
通讯作者：
Chastre J
中科院分区：
文献类型：
--
作者：
Luyt CE;Sahnoun T;Gautier M;Vidal P;Burrel S;Pineton de Chambrun M;Chommeloux J;Desnos C;Arzoine J;Nieszkowska A;Bréchot N;Schmidt M;Hekimian G;Boutolleau D;Robert J;Combes A;Chastre J
关于重症冠状病毒病2019(新冠肺炎)肺炎需要机械通气(MV)患者的呼吸机相关肺炎(VAP)的发生率、临床表现和转归的数据有限。我们开展了这项回顾性队列研究，以评估在2020年3月12日至4月24日期间需要机械通气治疗的新冠肺炎肺炎患者发生呼吸机相关性肺炎的频率、临床特征、责任病原体和预后(所有患者均经RT-PCR证实感染了SARS-CoV-2)。需要体外循环的新冠肺炎相关急性呼吸窘迫综合征患者与前三个冬季需要体外循环的45例严重流感相关急性呼吸窘迫综合征患者进行了比较。在50例需要体外循环治疗的新冠肺炎相关性ARDS患者中，43例(86%)出现VAP[首次发作前MV持续时间的中位数为10(8-16)天]。VAP病原菌以肠杆菌科为主(70%)，尤其是诱导产AmpC酶(40%)，其次为铜绿假单胞菌(37%)。VAP复发34例(79%)，死亡17例(34%)。大多数复发是复发(即感染相同的病原体)，在适当的抗菌治疗下发生的比例很高。将死亡和拔管作为相互竞争的事件考虑在内，新冠肺炎患者估计的呼吸机相关性肺炎累积发病率显著高于流感患者(p = 0.002)。尽管流感相关ARDS患者中铜绿假单胞菌-呼吸机相关性肺炎的发生率很高(54%)，但肺部感染复发率显著低于新冠肺炎患者。两组的总体死亡率相似。严重新冠肺炎相关性急性呼吸窘迫综合征需要体外反搏的患者有非常高的迟发性呼吸机相关性肺炎发生率。诱导型产AmpC-头孢菌素酶肠杆菌和铜绿假单胞菌常引起VAP，且多次复发，难以从肺部根除病原体。
The data on incidence, clinical presentation, and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited. We performed this retrospective cohort study to assess frequency, clinical characteristics, responsible pathogens, and outcomes of VAP in patients COVID-19 pneumonia requiring MV between March 12th and April 24th, 2020 (all had RT-PCR-confirmed SARS-CoV-2 infection). Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring ECMO were compared with an historical cohort of 45 patients with severe influenza-associated ARDS requiring ECMO admitted to the same ICU during the preceding three winter seasons. Among 50 consecutive patients with Covid-19-associated ARDS requiring ECMO included [median (IQR) age 48 (42–56) years; 72% male], 43 (86%) developed VAP [median (IQR) MV duration before the first episode, 10 (8–16) days]. VAP-causative pathogens were predominantly Enterobacteriaceae (70%), particularly inducible AmpC-cephalosporinase producers (40%), followed by Pseudomonas aeruginosa (37%). VAP recurred in 34 (79%) patients and 17 (34%) died. Most recurrences were relapses (i.e., infection with the same pathogen), with a high percentage occurring on adequate antimicrobial treatment. Estimated cumulative incidence of VAP, taking into account death and extubation as competing events, was significantly higher in Covid-19 patients than in influenza patients (p = 0.002). Despite a high P. aeruginosa-VAP rate in patients with influenza-associated ARDS (54%), the pulmonary infection recurrence rate was significantly lower than in Covid-19 patients. Overall mortality was similar for the two groups. Patients with severe Covid-19-associated ARDS requiring ECMO had a very high late-onset VAP rate. Inducible AmpC-cephalosporinase-producing Enterobacteriaceae and Pseudomonas aeruginosa frequently caused VAP, with multiple recurrences and difficulties eradicating the pathogen from the lung.
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影响因子：
24.3
作者：
Torres, Antoni;Niederman, Michael S.;Wunderink, Richard
通讯作者：
Wunderink, Richard
影响因子：
56.3
作者：
Niederman, Michael S.;Alder, Jeff;Chastre, Jean
通讯作者：
Chastre, Jean
影响因子：
39
作者：
Wu, Chaomin;Chen, Xiaoyan;Song, Yuanlin
通讯作者：
Song, Yuanlin
影响因子：
158.5
作者：
Ackermann, Maximilian;Verleden, Stijn E.;Jonigk, Danny
通讯作者：
Jonigk, Danny
影响因子：
56.3
作者：
Roberts, Jason A.;Abdul-Aziz, Mohd H.;Lipman, Jeffrey;Mouton, Johan W.;Vinks, Alexander A.;Felton, Timothy W.;Hope, William W.;Farkas, Andras;Neely, Michael N.;Schentag, Jerome J.;Drusano, George;Frey, Otto R.;Theuretzbacher, Ursula;Kuti, Joseph L.
通讯作者：
Kuti, Joseph L.