PDF(Pubmed)
Abstract：
Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring mechanical ventilation suffer from a high incidence of ventilator associated pneumonia (VAP), mainly related to Enterobacterales. Data regarding extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) VAP are scarce. We aimed to investigate risk factors and outcomes of ESBL-E related VAP among critically ill coronavirus infectious disease-19 (COVID-19) patients who developed Enterobacterales related VAP.
We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included.
We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19%), developed a first ESBL-E related VAP, mostly related to Enterobacter sp (n = 40), K. pneumoniae (n = 36), and E. coli (n = 31). Eight patients (1%) developed CRE related VAP. In a multivariable analysis, African origin (North Africa or Sub-Saharan Africa) (OR 1.7 [1.07-2.71], p = 0.02), time between intubation and VAP (OR 1.06 [1.02-1.09], p = 0.002), PaO2/FiO2 ratio on the day of VAP (OR 0.997 [0.994-0.999], p = 0.04) and trimethoprim-sulfamethoxazole exposure (OR 3.77 [1.15-12.4], p = 0.03) were associated with ESBL-E related VAP. Weaning from mechanical ventilation and mortality did not significantly differ between ESBL-E and non ESBL-E VAP.
ESBL-related VAP in COVID-19 critically-ill patients was not infrequent. Several risk factors were identified, among which some are modifiable and deserve further investigation. There was no impact of resistance of the first Enterobacterales related episode of VAP on outcome.
We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included.
We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19%), developed a first ESBL-E related VAP, mostly related to Enterobacter sp (n = 40), K. pneumoniae (n = 36), and E. coli (n = 31). Eight patients (1%) developed CRE related VAP. In a multivariable analysis, African origin (North Africa or Sub-Saharan Africa) (OR 1.7 [1.07-2.71], p = 0.02), time between intubation and VAP (OR 1.06 [1.02-1.09], p = 0.002), PaO2/FiO2 ratio on the day of VAP (OR 0.997 [0.994-0.999], p = 0.04) and trimethoprim-sulfamethoxazole exposure (OR 3.77 [1.15-12.4], p = 0.03) were associated with ESBL-E related VAP. Weaning from mechanical ventilation and mortality did not significantly differ between ESBL-E and non ESBL-E VAP.
ESBL-related VAP in COVID-19 critically-ill patients was not infrequent. Several risk factors were identified, among which some are modifiable and deserve further investigation. There was no impact of resistance of the first Enterobacterales related episode of VAP on outcome.
摘要：
背景：感染严重急性呼吸综合征冠状病毒2（SARS-COV2）并需要机械通气的患者，呼吸机相关性肺炎（VAP）的发生率很高，主要与肠杆菌有关。有关产超广谱β-内酰胺酶肠杆菌（ESBL-E）VAP的数据很少。我们旨在调查发生肠杆菌相关性VAP的重症冠状病毒感染性疾病-19（COVID-19）患者中ESBL-E相关性VAP的危险因素和结局。
方法：我们对一项多中心前瞻性国际队列研究（COVID-ICU）进行了辅助分析，该研究包括4929名COVID-19危重患者。对于目前的分析，仅具有有关肠杆菌相关性VAP（ESBL-E和/或碳青霉烯耐药肠杆菌，包括CRE）和结果。
结果：我们纳入了591例肠杆菌相关性VAP患者。主要致病菌是肠杆菌（n=224），大肠杆菌(n=111)和肺炎克雷伯菌(n=104)。115名患者（19%），开发了第一个ESBL-E相关的VAP，主要与肠杆菌相关(n=40)，肺炎克雷伯菌（n=36），和大肠杆菌(n=31)。8名患者(1%)发生CRE相关的VAP。在多变量分析中，非洲血统（北非或撒哈拉以南非洲）（OR1.7[1.07-2.71]，p=0.02),插管和VAP之间的时间（OR1.06[1.02-1.09]，p=0.002),VAP当天的PaO2/FiO2比率（OR0.997[0.994-0.999]，p=0.04）和甲氧苄啶-磺胺甲恶唑暴露（OR3.77[1.15-12.4]，p=0.03）与ESBL-E相关的VAP相关。ESBL-E和非ESBL-EVAP之间的机械通气撤机和死亡率没有显着差异。
结论：ESBL相关VAP在COVID-19危重症患者中并不少见。确定了几个风险因素，其中有些是可以修改的，值得进一步调查。首次肠杆菌相关性VAP发作的耐药性对结局没有影响。
方法：我们对一项多中心前瞻性国际队列研究（COVID-ICU）进行了辅助分析，该研究包括4929名COVID-19危重患者。对于目前的分析，仅具有有关肠杆菌相关性VAP（ESBL-E和/或碳青霉烯耐药肠杆菌，包括CRE）和结果。
结果：我们纳入了591例肠杆菌相关性VAP患者。主要致病菌是肠杆菌（n=224），大肠杆菌(n=111)和肺炎克雷伯菌(n=104)。115名患者（19%），开发了第一个ESBL-E相关的VAP，主要与肠杆菌相关(n=40)，肺炎克雷伯菌（n=36），和大肠杆菌(n=31)。8名患者(1%)发生CRE相关的VAP。在多变量分析中，非洲血统（北非或撒哈拉以南非洲）（OR1.7[1.07-2.71]，p=0.02),插管和VAP之间的时间（OR1.06[1.02-1.09]，p=0.002),VAP当天的PaO2/FiO2比率（OR0.997[0.994-0.999]，p=0.04）和甲氧苄啶-磺胺甲恶唑暴露（OR3.77[1.15-12.4]，p=0.03）与ESBL-E相关的VAP相关。ESBL-E和非ESBL-EVAP之间的机械通气撤机和死亡率没有显着差异。
结论：ESBL相关VAP在COVID-19危重症患者中并不少见。确定了几个风险因素，其中有些是可以修改的，值得进一步调查。首次肠杆菌相关性VAP发作的耐药性对结局没有影响。
