Jean-François Llitjos1,2, Swann Bredin3, Jean-Baptiste Lascarrou4, Thibaud Soumagne5, Mariana Cojocaru6, Maxime Leclerc7, Arnaud Lepetit7, Albin Gouhier8, Julien Charpentier3, Gaël Piton5, Matthieu Faron9, Annabelle Stoclin10, Frédéric Pène11,3. 1. 3i Department, Team Pulmonary and Systemic Immune Responses During Acute and Chronic Bacterial Infections, Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, Paris, France. jeanfrancois.llitjos@gustaveroussy.fr. 2. Intensive care unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France. jeanfrancois.llitjos@gustaveroussy.fr. 3. Medical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Centre, Paris, France. 4. Intensive Care Unit, Hôpital Hôtel-Dieu, Nantes, France. 5. Intensive Care Unit, Hôpital Jean Minjoz Hospital, Besançon, France. 6. Surgical Intensive Care Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, APHP, Centre, Paris, France. 7. Intensive Care Unit, Centre Hospitalier Mémorial France Etats-Unis, Saint-Lô, France. 8. Intensive Care Unit, Centre Hospitalier Intercommunal Alençon Mamers, Alençon, France. 9. Department of Biostatistics and Epidemiology, Inserm UNIT 1018 CESP Oncostat Team, Gustave Roussy Cancer Campus, Villejuif, France. 10. Intensive care unit, Gustave Roussy, Université Paris-Saclay, Villejuif, France. 11. 3i Department, Team Pulmonary and Systemic Immune Responses During Acute and Chronic Bacterial Infections, Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, Paris, France.
Abstract
BACKGROUND: The aim of this study is to determine whether severe COVID-19 patients harbour a higher risk of ICU-acquired pneumonia. METHODS: This retrospective multicentre cohort study comprised all consecutive patients admitted to seven ICUs for severe COVID-19 pneumonia during the first COVID-19 surge in France. Inclusion criteria were laboratory-confirmed SARS-CoV-2 infection and requirement for invasive mechanical ventilation for 48 h or more. Control groups were two historical cohorts of mechanically ventilated patients admitted to the ICU for bacterial or non-SARS-CoV-2 viral pneumonia. The outcome of interest was the development of ICU-acquired pneumonia. The determinants of ICU-acquired pneumonia were investigated in a multivariate competing risk analysis. RESULT: One hundred and seventy-six patients with severe SARS-CoV-2 pneumonia admitted to the ICU between March 1st and 30th June of 2020 were included into the study. Historical control groups comprised 435 patients with bacterial pneumonia and 48 ones with viral pneumonia. ICU-acquired pneumonia occurred in 52% of COVID-19 patients, whereas in 26% and 23% of patients with bacterial or viral pneumonia, respectively (p < 0.001). Times from initiation of mechanical ventilation to ICU-acquired pneumonia were similar across the three groups. In multivariate analysis, the risk of ICU-acquired pneumonia remained independently associated with underlying COVID-19 (SHR = 2.18; 95 CI 1.2-3.98, p = 0.011). CONCLUSION: COVID-19 appears an independent risk factor of ICU-acquired pneumonia in mechanically ventilated patients with pneumonia. Whether this is driven by immunomodulatory properties by the SARS-CoV-2 or this is related to particular processes of care remains to be investigated.
BACKGROUND: The aim of this study is to determine whether severe COVID-19patients harbour a higher risk of ICU-acquired pneumonia. METHODS: This retrospective multicentre cohort study comprised all consecutive patients admitted to seven ICUs for severe COVID-19 pneumonia during the first COVID-19 surge in France. Inclusion criteria were laboratory-confirmed SARS-CoV-2 infection and requirement for invasive mechanical ventilation for 48 h or more. Control groups were two historical cohorts of mechanically ventilated patients admitted to the ICU for bacterial or non-SARS-CoV-2 viral pneumonia. The outcome of interest was the development of ICU-acquired pneumonia. The determinants of ICU-acquired pneumonia were investigated in a multivariate competing risk analysis. RESULT: One hundred and seventy-six patients with severe SARS-CoV-2 pneumonia admitted to the ICU between March 1st and 30th June of 2020 were included into the study. Historical control groups comprised 435 patients with bacterial pneumonia and 48 ones with viral pneumonia. ICU-acquired pneumonia occurred in 52% of COVID-19patients, whereas in 26% and 23% of patients with bacterial or viral pneumonia, respectively (p < 0.001). Times from initiation of mechanical ventilation to ICU-acquired pneumonia were similar across the three groups. In multivariate analysis, the risk of ICU-acquired pneumonia remained independently associated with underlying COVID-19 (SHR = 2.18; 95 CI 1.2-3.98, p = 0.011). CONCLUSION:COVID-19 appears an independent risk factor of ICU-acquired pneumonia in mechanically ventilated patients with pneumonia. Whether this is driven by immunomodulatory properties by the SARS-CoV-2 or this is related to particular processes of care remains to be investigated.
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