Ventilator-Associated Lower Respiratory Tract Infections and Their Association With COVID-19: A Retrospective Cohort Study in a Portuguese Intensive Treatment Unit.

Publication date: Feb 01, 2024

Introduction Ventilator-associated pneumonia (VAP) is the most common infectious complication related to admission to an Intensive Treatment Unit (ITU). Ventilator-associated lower respiratory tract infection (VA-LRTI) is a broader diagnosis than VAP. By disregarding radiological criteria, it will include both VAP and ventilator-associated tracheobronchitis. This study, conducted in the setting of a Portuguese ITU, aims to study the incidence, microbiology and clinical outcome of VA-LRTI and its association with COVID-19. Methods A retrospective cohort study included patients admitted to a Portuguese ITU who underwent invasive mechanical ventilation (IMV) for over 48 hours between 01/01/2021 and 31/12/2021. The Hospitals in Europe Link for Infection Control through Surveillance (HELICS) criteria were applied, disregarding the radiological criteria, for the diagnosis of VA-LRTI. Results The group of patients with COVID-19 had 46. 38 episodes of VA-LRTI/1000 days of ventilation, while patients without COVID-19 had 16. 35 episodes/1000 days of ventilation (RR 2. 78, p < 0. 001). Of the 85 microorganisms isolated, 82% were gram-negative microorganisms, with species of the genus Klebsiella being the most prevalent (22. 4%). There was a lower prevalence of beta-lactam-resistant organisms in patients with COVID-19 (RR 0. 35, p = 0. 031). The development of VA-LRTI is associated with longer times of IMV (difference in medians 10 days, p < 0. 001), but with no significant differences in mortality (RR 1. 21, p = 0. 14). Discussion Patients with COVID-19 seem more predisposed to developing VA-LRTI, possibly due to intrinsic characteristics of the disease. Although no increase in mortality has been demonstrated, VA-LRTI can entail important costs related to morbidity, antibiotic pressure and economic costs that must be considered.

Concepts Keywords
Microbiology antimicrobial resistance
Pneumonia covid-19
Ventilator critical care
invasive mechanical ventilation
nosocomial infection
ventilator-associated pneumonia


Type Source Name
disease MESH COVID-19
disease MESH Ventilator-associated pneumonia
disease MESH Infection
disease MESH morbidity
disease MESH nosocomial infection

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