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Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia

Authors :
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
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

Details

ISSN :
15354970 and 1073449X
Volume :
204
Database :
OpenAIRE
Journal :
American Journal of Respiratory and Critical Care Medicine
Accession number :
edsair.doi.dedup.....7ba114cd4a15c58962a6add5711d8445