Risk factors for ventilator-associated lower respiratory tract infection in COVID-19, a retrospective multicenter cohort study in Sweden
© 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation..
BACKGROUND: Ventilator-associated lower respiratory tract infections (VA-LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA-LRTI have been reported among COVID-19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA-LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID-19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA-LTRI on morbidity and mortality.
METHODS: We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID-19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA-LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA-LRTI.
RESULTS: Of a total of 536 included patients, 153 (28.5%) developed VA-LRTI. Incidence rate of first VA-LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA-LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA-LRTI had fewer ventilator-free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds-ratio (aOR) for first VA-LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31-5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14-3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03-1.07]). Few multidrug-resistant pathogens were identified. Incidence of VA-LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves.
CONCLUSION: We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2024 |
---|---|
Erschienen: |
2024 |
Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
---|---|
Enthalten in: |
Acta anaesthesiologica Scandinavica - 68(2024), 2 vom: 27. Jan., Seite 226-235 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Forsberg, Gustaf [VerfasserIn] |
---|
Links: |
---|
Anmerkungen: |
Date Completed 18.01.2024 Date Revised 18.01.2024 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1111/aas.14338 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM362483264 |
---|
LEADER | 01000caa a22002652 4500 | ||
---|---|---|---|
001 | NLM362483264 | ||
003 | DE-627 | ||
005 | 20240118231918.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231226s2024 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1111/aas.14338 |2 doi | |
028 | 5 | 2 | |a pubmed24n1263.xml |
035 | |a (DE-627)NLM362483264 | ||
035 | |a (NLM)37751991 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Forsberg, Gustaf |e verfasserin |4 aut | |
245 | 1 | 0 | |a Risk factors for ventilator-associated lower respiratory tract infection in COVID-19, a retrospective multicenter cohort study in Sweden |
264 | 1 | |c 2024 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 18.01.2024 | ||
500 | |a Date Revised 18.01.2024 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a © 2023 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. | ||
520 | |a BACKGROUND: Ventilator-associated lower respiratory tract infections (VA-LRTI) increase morbidity and mortality in intensive care unit (ICU) patients. Higher incidences of VA-LRTI have been reported among COVID-19 patients requiring invasive mechanical ventilation (IMV). The primary objectives of this study were to describe clinical characteristics, incidence, and risk factors comparing patients who developed VA-LRTI to patients who did not, in a cohort of Swedish ICU patients with acute hypoxemic respiratory failure due to COVID-19. Secondary objectives were to decipher changes over the three initial pandemic waves, common microbiology and the effect of VA-LTRI on morbidity and mortality | ||
520 | |a METHODS: We conducted a multicenter, retrospective cohort study of all patients admitted to 10 ICUs in southeast Sweden between March 1, 2020 and May 31, 2021 because of acute hypoxemic respiratory failure due to COVID-19 and were mechanically ventilated for at least 48 h. The primary outcome was culture verified VA-LRTI. Patient characteristics, ICU management, clinical course, treatments, microbiological findings, and mortality were registered. Logistic regression analysis was conducted to determine risk factors for first VA-LRTI | ||
520 | |a RESULTS: Of a total of 536 included patients, 153 (28.5%) developed VA-LRTI. Incidence rate of first VA-LRTI was 20.8 per 1000 days of IMV. Comparing patients with VA-LRTI to those without, no differences in mortality, age, sex, or number of comorbidities were found. Patients with VA-LRTI had fewer ventilator-free days, longer ICU stay, were more frequently ventilated in prone position, received corticosteroids more often and were more frequently on antibiotics at intubation. Regression analysis revealed increased adjusted odds-ratio (aOR) for first VA-LRTI in patients treated with corticosteroids (aOR 2.64 [95% confidence interval [CI]] [1.31-5.74]), antibiotics at intubation (aOR 2.01 95% CI [1.14-3.66]), and days of IMV (aOR 1.05 per day of IMV, 95% CI [1.03-1.07]). Few multidrug-resistant pathogens were identified. Incidence of VA-LRTI increased from 14.5 per 1000 days of IMV during the first wave to 24.8 per 1000 days of IMV during the subsequent waves | ||
520 | |a CONCLUSION: We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI | ||
650 | 4 | |a Multicenter Study | |
650 | 4 | |a Journal Article | |
650 | 4 | |a COVID-19 | |
650 | 4 | |a SARS-CoV-2 | |
650 | 4 | |a Sweden | |
650 | 4 | |a acute respiratory distress syndrome (ARDS) | |
650 | 4 | |a intensive care | |
650 | 4 | |a multicenter | |
650 | 4 | |a ventilator-associated lower respiratory tract infection (VA-LRTI) | |
650 | 4 | |a ventilator-associated pneumonia (VAP) | |
650 | 4 | |a ventilator-associated respiratory infection (VARI) | |
650 | 7 | |a Adrenal Cortex Hormones |2 NLM | |
650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
700 | 1 | |a Taxbro, Knut |e verfasserin |4 aut | |
700 | 1 | |a Elander, Louise |e verfasserin |4 aut | |
700 | 1 | |a Hanberger, Håkan |e verfasserin |4 aut | |
700 | 1 | |a Berg, Sören |e verfasserin |4 aut | |
700 | 1 | |a Idh, Jonna |e verfasserin |4 aut | |
700 | 1 | |a Berkius, Johan |e verfasserin |4 aut | |
700 | 1 | |a Ekman, Andreas |e verfasserin |4 aut | |
700 | 1 | |a Hammarskjöld, Fredrik |e verfasserin |4 aut | |
700 | 1 | |a Niward, Katarina |e verfasserin |4 aut | |
700 | 1 | |a Balkhed, Åse Östholm |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Acta anaesthesiologica Scandinavica |d 1957 |g 68(2024), 2 vom: 27. Jan., Seite 226-235 |w (DE-627)NLM000055956 |x 1399-6576 |7 nnns |
773 | 1 | 8 | |g volume:68 |g year:2024 |g number:2 |g day:27 |g month:01 |g pages:226-235 |
856 | 4 | 0 | |u http://dx.doi.org/10.1111/aas.14338 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 68 |j 2024 |e 2 |b 27 |c 01 |h 226-235 |