Mortality, incidence, and microbiological documentation of ventilated acquired pneumonia (VAP) in critically ill patients with COVID-19 or influenza

Guillaume Laurichesse; Carole Schwebel; Niccolò Buetti; Mathilde Neuville; Shidasp Siami; Yves Cohen; Virginie Laurent; Bruno Mourvillier; Jean Reignier; Dany Goldgran-Toledano; Stéphane Ruckly; Etienne de Montmollin; Bertrand Souweine; Jean-François Timsit; Claire Dupuis; OUTCOME R. E. A. network

doi:10.1186/s13613-023-01207-9

Mortality, incidence, and microbiological documentation of ventilated acquired pneumonia (VAP) in critically ill patients with COVID-19 or influenza

Ann Intensive Care. 2023 Oct 30;13(1):108. doi: 10.1186/s13613-023-01207-9.

Authors

Guillaume Laurichesse¹, Carole Schwebel², Niccolò Buetti^{3

4}, Mathilde Neuville⁵, Shidasp Siami⁶, Yves Cohen⁷, Virginie Laurent⁸, Bruno Mourvillier⁹, Jean Reignier¹⁰, Dany Goldgran-Toledano¹¹, Stéphane Ruckly³, Etienne de Montmollin^{3

12}, Bertrand Souweine^{13

14}, Jean-François Timsit^{3

12}, Claire Dupuis^{15

16}; OUTCOME R. E. A. network

Affiliations

¹ Pneumology and infectious diseases Gabriel montpied hospital, Clermont Ferrand University Hospital, 63000, Clermont Ferrand, France.
² Medical Intensive Care Unit, University Hospital, Grenoble-Alpes, 38000, Grenoble, France.
³ UMR 1137, IAME, Université Paris Cité, 75018, Paris, France.
⁴ Infection Control Program and WHO Collaborating Centre on Patient Safety, Faculty of Medicine, University of Geneva Hospitals, 1205, Geneva, Switzerland.
⁵ Polyvalent Intensive Care Unit, Hôpital Foch, 92150, Suresnes, France.
⁶ General Intensive Care Unit, Sud Essonne Hospital, 91150, Etampes, France.
⁷ Intensive Care Unit, University Hospital Avicenne, AP-HP, 93000, Bobigny, France.
⁸ Polyvalent Intensive Care Unit, André Mignot Hospital, 78150, Le Chesnay, France.
⁹ Medical Intensive Care Unit, University Hospital of Reims, 51100, Reims, France.
¹⁰ Medical Intensive Care Unit, University Hospital of Nantes, 44000, Nantes, France.
¹¹ Medical and Surgical Intensive Care, Montfermeil Hospital, 93370, Montfermeil, France.
¹² Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, Paris Cité University, 46rue Henri Huchard, 75018, Paris, France.
¹³ Medical Intensive Care Unit, University Hospital Gabriel Montpied, 63000, Clermont-Ferrand, France.
¹⁴ Université Clermont Auvergne, UMR CNRS 6023 LMGE, 63000, Clermont-Ferrand, France.
¹⁵ Medical Intensive Care Unit, University Hospital Gabriel Montpied, 63000, Clermont-Ferrand, France. cdupuis1@chu-clermontferrand.fr.
¹⁶ Unité de Nutrition Humaine, CRNH Auvergne, INRAe, Université Clermont Auvergne, 63000, Clermont Ferrand, France. cdupuis1@chu-clermontferrand.fr.

Abstract

Background: Data on ventilator associated pneumonia (VAP) in COVID-19 and influenza patients admitted to intensive care units (ICU) are scarce. This study aimed to estimate day-60 mortality related to VAP in ICU patients ventilated for at least 48 h, either for COVID-19 or for influenza, and to describe the epidemiological characteristics in each group of VAP.

Design: Multicentre retrospective observational study.

Setting: Eleven ICUs of the French OutcomeRea^™ network.

Patients: Patients treated with invasive mechanical ventilation (IMV) for at least 48 h for either COVID-19 or for flu.

Results: Of the 585 patients included, 503 had COVID-19 and 82 had influenza between January 2008 and June 2021. A total of 232 patients, 209 (41.6%) with COVID-19 and 23 (28%) with influenza, developed 375 VAP episodes. Among the COVID-19 and flu patients, VAP incidences for the first VAP episode were, respectively, 99.2 and 56.4 per 1000 IMV days (p < 0.01), and incidences for all VAP episodes were 32.8 and 17.8 per 1000 IMV days (p < 0.01). Microorganisms of VAP were Gram-positive cocci in 29.6% and 23.5% of episodes of VAP (p < 0.01), respectively, including Staphylococcus aureus in 19.9% and 11.8% (p = 0.25), and Gram-negative bacilli in 84.2% and 79.4% (p = 0.47). In the overall cohort, VAP was associated with an increased risk of day-60 mortality (aHR = 1.77 [1.36; 2.30], p < 0.01), and COVID-19 had a higher mortality risk than influenza (aHR = 2.22 [CI 95%, 1.34; 3.66], p < 0.01). VAP was associated with increased day-60 mortality among COVID-19 patients (aHR = 1.75 [CI 95%, 1.32; 2.33], p < 0.01), but not among influenza patients (aHR = 1.75 [CI 95%, 0.48; 6.33], p = 0.35).

Conclusion: The incidence of VAP was higher in patients ventilated for at least 48 h for COVID-19 than for influenza. In both groups, Gram-negative bacilli were the most frequently detected microorganisms. In patients ventilated for either COVID-19 or influenza VAP and COVID-19 were associated with a higher risk of mortality.