Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
| Autor: | Chiagozie O. Pickens, Catherine A. Gao, Michael J. Cuttica, Sean B. Smith, Lorenzo L. Pesce, Rogan A. Grant, Mengjia Kang, Luisa Morales-Nebreda, Avni A. Bavishi, Jason M. Arnold, Anna Pawlowski, Chao Qi, G. R. Scott Budinger, Benjamin D. Singer, Richard G. Wunderink, A. Christine Argento, Ajay A. Wagh, Alexander V. Misharin, Alexandra C. McQuattie-Pimentel, Alexis Rose Wolfe, Alvaro Donayre, Ankit Bharat, Anne R. Levenson, Anthony M. Joudi, Betty Tran, Chitaru Kurihara, Clara J Schroedl, Daniel Meza, Daniel Schneider, David A. Kidd, David D. Odell, David W. Kamp, Elizabeth S. Malsin, Emily M. Leibenguth, Eric P. Cantey, Gabrielle Y. Liu, Helen K. Donnelly, Isaac A. Goldberg, Jacob I. Sznajder, Jacqueline M. Kruser, James M. Walter, Jane E. Dematte, John Coleman, Joseph I. Bailey, Joseph S. Deters, Justin A. Fiala, Katharine Secunda, Kaitlyn Vitale, Khalilah L. Gates, Kristy Todd, Lindsey D. Gradone, Lindsey N. Textor, Lisa F. Wolfe, Madeline L. Rosenbaum, Manu Jain, Marc A. Sala, Mary Carns, Marysa V. Leya, Michael J. Alexander, Michelle Hinsch Prickett, Natalie Jensema, Nicole Borkowski, Nikolay S. Markov, Orlyn R. Rivas, Paul A. Reyfman, Peter H. S. Sporn, Prasanth Nannapaneni, Rachel B. Kadar, Rachel M. Kaplan, Rade Tomic, Radhika Patel, Rafael Garza-Castillon, Ravi Kalhan, Romy Lawrence, Ruben J. Mylvaganam, Samuel S. Kim, Sanket Thakkar, SeungHye Han, Sharon R. Rosenberg, Susan R. Russell, Sydney M. Hyder, Taylor A. Poor, Theresa A. Lombardo, Zasu M. Klug |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty community-acquired pneumonia medicine.drug_class viruses medicine.medical_treatment Antibiotics Critical Care and Intensive Care Medicine ventilator-associated pneumonia Community-acquired pneumonia Internal medicine guideline therapy medicine bronchoalveolar lavage Humans Intubation COVID-19/Pulmonary Infections Mechanical ventilation Bacteria medicine.diagnostic_test SARS-CoV-2 business.industry Incidence (epidemiology) Ventilator-associated pneumonia COVID-19 Original Articles medicine.disease respiratory tract diseases Pneumonia Bronchoalveolar lavage Superinfection business |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/rccm.202106-1354oc |
| Popis: | Rationale: Current guidelines recommend patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia receive empirical antibiotics for suspected bacterial superinfection on the basis of weak evidence. Rates of ventilator-associated pneumonia (VAP) in clinical trials of patients with SARS-CoV-2 pneumonia are unexpectedly low. Objectives: We conducted an observational single-center study to determine the prevalence and etiology of bacterial superinfection at the time of initial intubation and the incidence and etiology of subsequent bacterial VAP in patients with severe SARS-CoV-2 pneumonia. Methods: Bronchoscopic BAL fluid samples from all patients with SARS-CoV-2 pneumonia requiring mechanical ventilation were analyzed using quantitative cultures and a multiplex PCR panel. Actual antibiotic use was compared with guideline-recommended therapy. Measurements and Main Results: We analyzed 386 BAL samples from 179 patients with SARS-CoV-2 pneumonia requiring mechanical ventilation. Bacterial superinfection within 48 hours of intubation was detected in 21% of patients. Seventy-two patients (44.4%) developed at least one VAP episode (VAP incidence rate = 45.2/1,000 ventilator days); 15 (20.8%) initial VAPs were caused by difficult-to-treat pathogens. The clinical criteria did not distinguish between patients with or without bacterial superinfection. BAL-based management was associated with significantly reduced antibiotic use compared with guideline recommendations. Conclusions: In patients with SARS-CoV-2 pneumonia requiring mechanical ventilation, bacterial superinfection at the time of intubation occurs in |
| Databáze: | OpenAIRE |
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