Ventilator-associated pneumonia ‘a major factor’ for poor prognosis in patients with COVID-19
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In a new study, ventilator-associated pneumonia-related mortality was higher among patients with COVID-19 compared with those without COVID-19, with more than 9% of overall mortality attributable to ventilator-associated pneumonia.
“The occurrence of ventilator-associated pneumonia is a major factor of poor prognosis in patients with COVID-19,” Charles-Hervé Vacheron, MD, of the department of anesthesia and intensive care at Centre Hospitalier Lyon Sud in Pierre-Bénite, France, and colleagues wrote in the American Journal of Respiratory and Critical Care Medicine. “The causal interference analysis performed herein showed that when patients with COVID-19 are exposed to ventilator-associated pneumonia, their risk of death tends to increase compared with patients without COVID-19, and that they are at a lower risk of death if they do not acquire ventilator-associated pneumonia.”
Researchers utilized the REA-REZO surveillance network to identify three groups of adults who had been hospitalized in the ICU: a control group admitted before the pandemic from 2016 to 2019 (n = 64,816), a pandemic COVID-19 group (n = 1,687) and a pandemic non-COVID-19 group (n = 7,442) both admitted during 2020.
The primary outcome was the estimation of attributable mortality and fraction related to ventilator-associated pneumonia among these patients.
The incidence of ventilator-associated pneumonia was 14.2 per 1,000 ventilation-days in the control group, 18.3 per 1,000 ventilation-days in the pandemic non-COVID-19 group and 31.9 per 1,000 ventilation-days in the pandemic COVID-19 group.
At 90 days, attributable ventilator-associated pneumonia was 3.15% in the control group, 2.91% in the pandemic non-COVID-19 group and 8.13% in the pandemic COVID-19 group. Attributable fraction of ventilator-associated pneumonia mortality at 90 days was 1.22% in the control group, 1.42% in the pandemic non-COVID-19 group and 9.17% in the pandemic COVID-19 group.
Patients in the pandemic non-COVID-19 group had similar characteristics of ventilator-associated pneumonia with patients in the control group. However, patients in the pandemic COVID-19 group had a lower risk for mortality without ventilator-associated pneumonia (HR = 0.62; 95% CI, 0.52-0.74) compared with patients in the control group.
“A potential benefit of the prevention of ventilator-associated pneumonia in patients with COVID-19 hospitalized in the ICU would be a reduction of overall mortality of nearly 10% at 90 days,” the researchers wrote.