Relationship between SARS-CoV-2 infection and the incidence of ventilator-associated lower respiratory tract infections: a European multicenter cohort study

Rouzé, Anahita; Martin-Loeches, Ignacio; Povoa, Pedro; Makris, Demosthenes; Artigas, Antonio; Bouchereau, Mathilde; Lambiotte, Fabien; Metzelard, Matthieu; Cuchet, Pierre; Boulle Geronimi, Claire; Labruyere, Marie; Tamion, Fabienne; Nyunga, Martine; Luyt, Charles-Edouard; Labreuche, Julien; Pouly, Olivier; Bardin, Justine; Saade, Anastasia; Asfar, Pierre; Baudel, Jean-Luc; Beurton, Alexandra; Garot, Denis; Ioannidou, Iliana; Kreitmann, Louis; Llitjos, Jean-François; Magira, Eleni; Mégarbane, Bruno; Meguerditchian, David; Moglia, Edgar; Mekontso-Dessap, Armand; Reignier, Jean; Turpin, Matthieu; Pierre, Alexandre; Plantefeve, Gaetan; Vinsonneau, Christophe; Floch, Pierre-Edouard; Weiss, Nicolas; Ceccato, Adrian; Torres, Antoni; Duhamel, Alain; Nseir, Saad

PURPOSE: Although patients with SARS-CoV-2 infection have several risk factors for ventilator-associated lower respiratory tract infections (VA-LRTI), the reported incidence of hospital-acquired infections is low. We aimed to determine the relationship between SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, and the incidence of VA-LRTI. METHODS: Multicenter retrospective European cohort performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation > 48 h were eligible if they had: SARS-CoV-2 pneumonia, influenza pneumonia, or no viral infection at ICU admission. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. All VA-LRTI were prospectively identified, and chest-X rays were analyzed by at least two physicians. Cumulative incidence of first episodes of VA-LRTI was estimated using the Kalbfleisch and Prentice method, and compared using Fine-and Gray models. RESULTS: 1576 patients were included (568 in SARS-CoV-2, 482 in influenza, and 526 in no viral infection groups). VA-LRTI incidence was significantly higher in SARS-CoV-2 patients (287, 50.5%), as compared to influenza patients (146, 30.3%, adjusted sub hazard ratio (sHR) 1.60 (95% confidence interval (CI) 1.26 to 2.04)) or patients with no viral infection (133, 25.3%, adjusted sHR 1.7 (95% CI 1.2 to 2.39)). Gram-negative bacilli were responsible for a large proportion (82% to 89.7%) of VA-LRTI, mainly Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp. CONCLUSIONS: The incidence of VA-LRTI is significantly higher in patients with SARS-CoV-2 infection, as compared to patients with influenza pneumonia, or no viral infection after statistical adjustment, but residual confounding may still play a role in the effect estimates. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06323-9) contains supplementary material, which is available to authorized users.