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Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia
- Source :
- American Journal of Respiratory and Critical Care Medicine
- Publication Year :
- 2021
- Publisher :
- American Thoracic Society, 2021.
-
Abstract
- 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
- Subjects :
- 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
Subjects
Details
- ISSN :
- 15354970 and 1073449X
- Volume :
- 204
- Database :
- OpenAIRE
- Journal :
- American Journal of Respiratory and Critical Care Medicine
- Accession number :
- edsair.doi.dedup.....7ba114cd4a15c58962a6add5711d8445