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Biomedicines
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Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19
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Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Microbiology in Human Health and Disease".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 12018

Special Issue Editor

Dr. Alessandro Russo

E-Mail Website
Guest Editor
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Catanzaro, Italy
Interests: septic shock; multidrug-resistant pathogens; severe infections; hospital infections; antimicrobials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

COVID-19 patients admitted to the intensive care unit (ICU) may require mechanical ventilation for a long time, putting them at risk of developing bacterial superinfections, including ventilator-associated pneumonia (VAP), which may contribute to unfavorable outcomes and death. However, final data about the true incidence rate, spectrum of causative agents, and prognostic factors of VAP in COVID-19 patients, which may help physicians to improve its management, are still unavailable.

The available data highlight the role of multidrug-resistant (MDR) pathogens also in COVID-19 patients developing VAP, while a definitive role of invasive pulmonary aspergillosis should also be assessed.

Based on the aforementioned information, knowledge around the clinical characteristics of VAP in COVID-19 patients, including choices and dosages of antimicrobials, is crucial when it comes to improving the outcome of these patients.

This Special Issue aims to expand the current knowledge on VAP in COVID-19 patients in different stages and on its possible therapeutic exploitation. We aim to address the key roles of mechanisms of infection susceptibility, clinical presentation, and outcomes. Brief reports, reviews, and clinical studies are welcome for consideration.

Prof. Dr. Alessandro Russo
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ventilator-associated pneumonia
  • COVID-19
  • superinfections
  • MDR pathogens
  • bacterial pneumonia
  • invasive pulmonary aspergillosis
  • antimicrobial therapy
  • septic shock

Published Papers (6 papers)

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15 pages, 2278 KiB  
Article
Investigation of hs-TnI and sST-2 as Potential Predictors of Long-Term Cardiovascular Risk in Patients with Survived Hospitalization for COVID-19 Pneumonia
by Lukas Fiedler, Lukas J. Motloch, Peter Jirak, Ruslan Gumerov, Paruir Davtyan, Diana Gareeva, Irina Lakman, Alexandr Tataurov, Gulnaz Lasinova, Valentin Pavlov, Laurenz Hauptmann, Kristen Kopp, Uta C. Hoppe, Michael Lichtenauer, Rudin Pistulli, Anna-Maria Dieplinger and Naufal Zagidullin
Biomedicines 2022, 10(11), 2889; https://doi.org/10.3390/biomedicines10112889 - 10 Nov 2022
Cited by 4 | Viewed by 1722
Abstract
Introduction: COVID-19 survivors reveal an increased long-term risk for cardiovascular disease. Biomarkers like troponins and sST-2 improve stratification of cardiovascular risk. Nevertheless, their prognostic value for identifying long-term cardiovascular risk after having survived COVID-19 has yet to be evaluated. Methods: In this single-center [...] Read more.
Introduction: COVID-19 survivors reveal an increased long-term risk for cardiovascular disease. Biomarkers like troponins and sST-2 improve stratification of cardiovascular risk. Nevertheless, their prognostic value for identifying long-term cardiovascular risk after having survived COVID-19 has yet to be evaluated. Methods: In this single-center study, admission serum biomarkers of sST-2 and hs-TnI in a single cohort of 251 hospitalized COVID-19 survivors were evaluated. Concentrations were correlated with major cardiovascular events (MACE) defined as cardiovascular death and/or need for cardiovascular hospitalization during follow-up after hospital discharge [FU: 415 days (403; 422)]. Results: MACE was a frequent finding during FU with an incidence of 8.4% (cardiovascular death: 2.8% and/or need for cardiovascular hospitalization: 7.2%). Both biomarkers were reliable indicators of MACE (hs-TnI: sensitivity = 66.7% & specificity = 65.7%; sST-2: sensitivity = 33.3% & specificity = 97.4%). This was confirmed in a multivariate proportional-hazards analysis: besides age (HR = 1.047, 95% CI = 1.012–1.084, p = 0.009), hs-TnI (HR = 4.940, 95% CI = 1.904–12.816, p = 0.001) and sST-2 (HR = 10.901, 95% CI = 4.509–29.271, p < 0.001) were strong predictors of MACE. The predictive value of the model was further improved by combining both biomarkers with the factor age (concordance index hs-TnI + sST2 + age = 0.812). Conclusion: During long-term FU, hospitalized COVID-19 survivors, hs-TnI and sST-2 at admission, were strong predictors of MACE, indicating both proteins to be involved in post-acute sequelae of COVID-19. Full article
(This article belongs to the Special Issue Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19)
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14 pages, 982 KiB  
Article
Bacterial Pulmonary Co-Infections on ICU Admission: Comparison in Patients with SARS-CoV-2 and Influenza Acute Respiratory Failure: A Multicentre Cohort Study
by Grégoire Delhommeau, Niccolò Buetti, Mathilde Neuville, Shidasp Siami, Yves Cohen, Virginie Laurent, Bruno Mourvillier, Jean Reignier, Dany Goldgran-Toledano, Carole Schwebel, Stéphane Ruckly, Etienne de Montmollin, Bertrand Souweine, Jean-François Timsit and Claire Dupuis
Biomedicines 2022, 10(10), 2646; https://doi.org/10.3390/biomedicines10102646 - 20 Oct 2022
Cited by 3 | Viewed by 1433
Abstract
Background: Few data are available on the impact of bacterial pulmonary co-infection (RespCoBact) during COVID-19 (CovRespCoBact). The aim of this study was to compare the prognosis of patients admitted to an ICU for influenza pneumonia and for SARS-CoV-2 pneumonia with and without RespCoBact. [...] Read more.
Background: Few data are available on the impact of bacterial pulmonary co-infection (RespCoBact) during COVID-19 (CovRespCoBact). The aim of this study was to compare the prognosis of patients admitted to an ICU for influenza pneumonia and for SARS-CoV-2 pneumonia with and without RespCoBact. Methods: This was a multicentre (n = 11) observational study using the Outcomerea© database. Since 2008, all patients admitted with influenza pneumonia or SARS-CoV-2 pneumonia and discharged before 30 June 2021 were included. Risk factors for day-60 death and for ventilator-associated-pneumonia (VAP) in patients with influenza pneumonia or SARS-CoV-2 pneumonia with or without RespCoBact were determined. Results: Of the 1349 patients included, 157 were admitted for influenza and 1192 for SARS-CoV-2. Compared with the influenza patients, those with SARS-CoV-2 had lower severity scores, were more often under high-flow nasal cannula, were less often under invasive mechanical ventilation, and had less RespCoBact (8.2% for SARS-CoV-2 versus 24.8% for influenza). Day-60 death was significantly higher in patients with SARS-CoV-2 pneumonia with no increased risk of mortality with RespCoBact. Patients with influenza pneumonia and those with SARS-CoV-2 pneumonia had no increased risk of VAP with RespCoBact. Conclusions: SARS-CoV-2 pneumonia was associated with an increased risk of mortality compared with Influenza pneumonia. Bacterial pulmonary co-infections on admission were not associated with patient survival rates nor with an increased risk of VAP. Full article
(This article belongs to the Special Issue Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19)
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13 pages, 1209 KiB  
Article
Co-Infection and Ventilator-Associated Pneumonia in Critically Ill COVID-19 Patients Requiring Mechanical Ventilation: A Retrospective Cohort Study
by Benjamine Sarton, Marion Grare, Fanny Vardon-Bounes, Anna Gaubert, Stein Silva, Laure Crognier, Béatrice Riu, Thierry Seguin, Bernard Georges, Vincent Minville and Stéphanie Ruiz
Biomedicines 2022, 10(8), 1952; https://doi.org/10.3390/biomedicines10081952 - 11 Aug 2022
Cited by 2 | Viewed by 1647
Abstract
Considering virus-related and drug-induced immunocompromised status of critically ill COVID-19 patients, we hypothesize that these patients would more frequently develop ventilator-associated pneumonia (VAP) than patients with ARDS from other viral causes. We conducted a retrospective observational study in two intensive care units (ICUs) [...] Read more.
Considering virus-related and drug-induced immunocompromised status of critically ill COVID-19 patients, we hypothesize that these patients would more frequently develop ventilator-associated pneumonia (VAP) than patients with ARDS from other viral causes. We conducted a retrospective observational study in two intensive care units (ICUs) from France, between 2017 and 2020. We compared bacterial co-infection at ICU admission and throughout the disease course of two retrospective longitudinally sampled groups of critically ill patients, who were admitted to ICU for either H1N1 or SARS-CoV-2 respiratory infection and depicted moderate-to-severe ARDS criteria upon admission. Sixty patients in the H1N1 group and 65 in the COVID-19 group were included in the study. Bacterial co-infection at the endotracheal intubation time was diagnosed in 33% of H1N1 and 16% COVID-19 patients (p = 0.08). The VAP incidence per 100 days of mechanical ventilation was 3.4 (2.2–5.2) in the H1N1 group and 7.2 (5.3–9.6) in the COVID-19 group (p < 0.004). The HR to develop VAP was of 2.33 (1.34–4.04) higher in the COVID-19 group (p = 0.002). Ten percent of H1N1 patients and 30% of the COVID-19 patients had a second episode of VAP (p = 0.013). COVID-19 patients have fewer bacterial co-infections upon admission, but the incidence of secondary infections increased faster in this group compared to H1N1 patients. Full article
(This article belongs to the Special Issue Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19)
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12 pages, 923 KiB  
Article
Clinical Characteristics and Outcome of Hospitalized COVID-19 Patients Treated with Standard Dose of Dexamethasone or High Dose of Methylprednisolone
by Alessandro Russo, Chiara Davoli, Cristian Borrazzo, Vincenzo Olivadese, Giancarlo Ceccarelli, Paolo Fusco, Alessandro Lazzaro, Rosaria Lionello, Marco Ricchio, Francesca Serapide, Bruno Tassone, Elio Gentilini Cacciola, Claudio Maria Mastroianni, Carlo Torti, Gabriella d’Ettorre and Enrico Maria Trecarichi
Biomedicines 2022, 10(7), 1548; https://doi.org/10.3390/biomedicines10071548 - 29 Jun 2022
Cited by 3 | Viewed by 1253
Abstract
The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including [...] Read more.
The hyperinflammatory phase represents the main cause for the clinical worsening of acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19), leading to the hypothesis that steroid therapy could be a mainstream treatment in COVID-19 patients. This is an observational study including all consecutive patients admitted to two Italian University Hospitals for COVID-19 from March 2020 to December 2021. The aim of this study was to describe clinical characteristics and outcome parameters of hospitalized COVID-19 patients treated with dexamethasone 6 mg once daily (standard-dose group) or methylprednisolone 40 mg twice daily (high-dose group). The primary outcome was the impact of these different steroid treatments on 30-day mortality. During the study period, 990 patients were evaluated: 695 (70.2%) receiving standard dosage of dexamethasone and 295 (29.8%) receiving a high dose of methylprednisolone. Cox regression analysis showed that chronic obstructive pulmonary disease (HR 1.98, CI95% 1.34–9.81, p = 0.002), chronic kidney disease (HR 5.21, CI95% 1.48–22.23, p = 0.001), oncologic disease (HR 2.81, CI95% 1.45–19.8, p = 0.005) and high-flow nasal cannula, continuous positive airway pressure or non-invasive ventilation oxygen therapy (HR 61.1, CI95% 5.12–511.1, p < 0.001) were independently associated with 30-day mortality; conversely, high-dose steroid therapy was associated with survival (HR 0.42, CI95% 0.38–0.86, p = 0.002) at 30 days. Kaplan–Meier curves for 30-day survival displayed a statistically significant better survival rate in patients treated with high-dose steroid therapy (p = 0.018). The results of this study highlighted that the use of high-dose methylprednisolone, compared to dexamethasone 6 mg once daily, in hospitalized patients with COVID-19 may be associated with a significant reduction in mortality. Full article
(This article belongs to the Special Issue Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19)
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13 pages, 600 KiB  
Article
Critical Care in SARS-CoV-2 Infected Pregnant Women: A Prospective Multicenter Study
by Ana Álvarez Bartolomé, Nadia Akram Abdallah Kassab, Sara Cruz Melguizo, María Luisa de la Cruz Conty, Laura Forcen Acebal, Alejandra Abascal Saiz, Pilar Pintado Recarte, Alicia Martinez Varea, Lucas Cerrillos Gonzalez, Javier García Fernández and Oscar Martínez Pérez
Biomedicines 2022, 10(2), 475; https://doi.org/10.3390/biomedicines10020475 - 17 Feb 2022
Cited by 8 | Viewed by 2259
Abstract
Evidence suggests that pregnant women are at a higher risk of complications compared to the general population when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the reasons that lead them to need intensive care are not clear. This is a [...] Read more.
Evidence suggests that pregnant women are at a higher risk of complications compared to the general population when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the reasons that lead them to need intensive care are not clear. This is a prospective multicenter study of SARS-CoV-2 positive pregnant women, registered by the Spanish Obstetric Emergency Group, with the objective to define the characteristics of the mothers who were admitted to the Intensive Care Unit (ICU) and to investigate the causes and risk factors for ICU admission. A total of 1347 infected pregnant women were registered and analyzed, of whom, 35 (2.6%) were admitted to the ICU. No differences in maternal characteristics or comorbidities were observed between ICU and non-ICU patients, except for in vitro fertilization and multiple pregnancies. The main causes of admission to the ICU were non-obstetric causes (worsening of the maternal condition and respiratory failure due to SARS-CoV-2 pneumonia, 40%) and a combination of coronavirus disease 2019 (COVID-19) symptoms and obstetrical complications (31.4%). The multivariable logistic analysis confirmed a higher risk of ICU admission when pre-eclampsia or hemorrhagic events coexist with pneumonia. The incidence of thromboembolic events and disseminated intravascular coagulation were also significantly higher among patients admitted to the ICU. Therefore, surveillance and rapid intervention should be intensified in SARS-CoV-2 infected pregnant women with the mentioned risk factors and complications. Emphasis should always be placed on anticoagulant therapy in these patients due to the increased thromboembolic risk, C-section surgery and immobilization in the ICU. Full article
(This article belongs to the Special Issue Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19)
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12 pages, 804 KiB  
Systematic Review
Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review
by Larry Velásquez-Garcia, Ana Mejia-Sanjuanelo, Diego Viasus and Jordi Carratalà
Biomedicines 2022, 10(6), 1226; https://doi.org/10.3390/biomedicines10061226 - 24 May 2022
Cited by 12 | Viewed by 2379
Abstract
Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents of VAP and resistance to antibiotics in COVID-19 patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, [...] Read more.
Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents of VAP and resistance to antibiotics in COVID-19 patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, and LILACS databases from December 2019 to December 2021. Studies that described the frequency of causative pathogens associated with VAP and their antibiotic resistance patterns in critically ill COVID-19 adult patients were included. The Newcastle-Ottawa Quality Assessment Scale was used for critical appraisal. The data are presented according to the number or proportions reported in the studies. A total of 25 articles were included, involving 2766 VAP cases in COVID-19 patients (range 5–550 VAP cases). Most of the studies included were carried out in France (32%), Italy (20%), Spain (12%) and the United States (8%). Gram-negative bacteria were the most frequent causative pathogens of VAP (range of incidences in studies: P. aeruginosa 7.5–72.5%, K. pneumoniae 6.9–43.7%, E. cloacae 1.6–20% and A. baumannii 1.2–20%). S. aureus was the most frequent Gram-positive pathogen, with a range of incidence of 3.3–57.9%. The median incidence of Aspergillus spp. was 6.4%. Few studies have recorded susceptibility patterns among Gram-negative causative pathogens and have mainly reported extended-spectrum beta-lactamase (ESBL), AmpC, and carbapenem resistance. The median frequency of methicillin resistance among S. aureus isolates was 44.4%. Our study provides the first comprehensive description of the causative agents and antibiotic resistance in COVID-19 patients with VAP. Gram-negative bacteria were the most common pathogens causing VAP. Data on antibiotic resistance patterns in the published medical literature are limited, as well as information about VAP from low- and middle-income countries. Full article
(This article belongs to the Special Issue Issues and Challenges in Ventilator-Associated Pneumonia in COVID-19)
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