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Delhommeau G, Buetti N, Neuville M, Siami S, Cohen Y, Laurent V, Mourvillier B, Reignier J, Goldgran-Toledano D, Schwebel C, Ruckly S, de Montmollin E, Souweine B, Timsit JF, Dupuis C. Bacterial Pulmonary Co-Infections on ICU Admission: Comparison in Patients with SARS-CoV-2 and Influenza Acute Respiratory Failure: A Multicentre Cohort Study. Biomedicines 2022; 10:biomedicines10102646. [PMID: 36289906 PMCID: PMC9599916 DOI: 10.3390/biomedicines10102646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Few data are available on the impact of bacterial pulmonary co-infection (RespCoBact) during COVID-19 (CovRespCoBact). The aim of this study was to compare the prognosis of patients admitted to an ICU for influenza pneumonia and for SARS-CoV-2 pneumonia with and without RespCoBact. Methods: This was a multicentre (n = 11) observational study using the Outcomerea© database. Since 2008, all patients admitted with influenza pneumonia or SARS-CoV-2 pneumonia and discharged before 30 June 2021 were included. Risk factors for day-60 death and for ventilator-associated-pneumonia (VAP) in patients with influenza pneumonia or SARS-CoV-2 pneumonia with or without RespCoBact were determined. Results: Of the 1349 patients included, 157 were admitted for influenza and 1192 for SARS-CoV-2. Compared with the influenza patients, those with SARS-CoV-2 had lower severity scores, were more often under high-flow nasal cannula, were less often under invasive mechanical ventilation, and had less RespCoBact (8.2% for SARS-CoV-2 versus 24.8% for influenza). Day-60 death was significantly higher in patients with SARS-CoV-2 pneumonia with no increased risk of mortality with RespCoBact. Patients with influenza pneumonia and those with SARS-CoV-2 pneumonia had no increased risk of VAP with RespCoBact. Conclusions: SARS-CoV-2 pneumonia was associated with an increased risk of mortality compared with Influenza pneumonia. Bacterial pulmonary co-infections on admission were not associated with patient survival rates nor with an increased risk of VAP.
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Affiliation(s)
- Grégoire Delhommeau
- Service de Pneumologie, CHU Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Niccolò Buetti
- Unité Mixte de Recherche (UMR) 1137, IAME, Université Paris Cité, 75018 Paris, France
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Faculty of Medicine, University of Geneva Hospitals, 1205 Geneva, Switzerland
| | - Mathilde Neuville
- Polyvalent Intensive Care Unit, Hôpital Foch, 92150 Suresnes, France
| | - Shidasp Siami
- General Intensive Care Unit, Sud Essonne Hospital, 91150 Etampes, France
| | - Yves Cohen
- Intensive Care Unit, University Hospital Avicenne, AP-HP, 93000 Bobigny, France
| | - Virginie Laurent
- Polyvalent Intensive Care Unit, André Mignot Hospital, 78150 Le Chesnay, France
| | - Bruno Mourvillier
- Medical Intensive Care Unit, University Hospital of Reims, 51100 Reims, France
| | - Jean Reignier
- Medical Intensive Care Unit, University Hospital of Nantes, 44000 Nantes, France
| | | | - Carole Schwebel
- Medical Intensive Care Unit, University Hospital Grenoble-Alpes, 38000 Grenoble, France
| | - Stéphane Ruckly
- Unité Mixte de Recherche (UMR) 1137, IAME, Université Paris Cité, 75018 Paris, France
| | - Etienne de Montmollin
- Unité Mixte de Recherche (UMR) 1137, IAME, Université Paris Cité, 75018 Paris, France
- Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Bertrand Souweine
- Medical Intensive Care Unit, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
| | - Jean-François Timsit
- Unité Mixte de Recherche (UMR) 1137, IAME, Université Paris Cité, 75018 Paris, France
- Medical and Infectious Diseases Intensive Care Unit, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Claire Dupuis
- Medical Intensive Care Unit, University Hospital Gabriel Montpied, 63000 Clermont-Ferrand, France
- Unité de Nutrition Humaine, INRAe, CRNH Auvergne, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- Correspondence: ; Tel.: +33-473-754-492
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Impact of Cardiovascular Failure in Intensive CareUnit-Acquired Pneumonia: A Single-Center, Prospective Study. Antibiotics (Basel) 2021; 10:antibiotics10070798. [PMID: 34209181 PMCID: PMC8300830 DOI: 10.3390/antibiotics10070798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Cardiovascular failure (CVF) may complicate intensive care unit-acquired pneumonia (ICUAP) and radically alters the empirical treatment of this condition. The aim of this study was to determine the impact of CVF on outcome in patients with ICUAP. Methods: A prospective, single-center, observational study was conducted in six medical and surgical ICUs at a University Hospital. CVS was defined as a score of 3 or more on the cardiovascular component of the Sequential Organ Failure Assessment (SOFA) score. At the onset of ICUAP, CVF was reported as absent, transient (if lasting ≤ 3 days) or persistent (>3 days). The primary outcome was 90-day mortality modelled through a Cox regression analysis. Secondary outcomes were 28-day mortality, hospital mortality, ICU length of stay (LOS) and hospital LOS. Results: 358 patients were enrolled: 203 (57%) without CVF, 82 (23%) with transient CVF, and 73 (20%) with persistent CVF. Patients with transient and persistent CVF were more severely ill and presented higher inflammatory response than those without CVF. Despite having similar severity and aetiology, the persistent CVF group more frequently received inadequate initial antibiotic treatment and presented more treatment failures than the transient CVF group. In the persistent CVF group, at day 3, a bacterial superinfection was more frequently detected. The 90-day mortality was significantly higher in the persistent CVF group (62%). The 28-day mortality rates for patients without CVF, with transient and with persistent CVF were 19, 35 and 41% respectively and ICU mortality was 60, 38 and 19% respectively. In the multivariate analysis chronic pulmonary conditions, lack of Pa02/FiO2 improvement at day 3, pulmonary superinfection at day 3 and persistent CVF were independently associated with 90-day mortality in ICUAP patients. Conclusions: Persistent CVF has a significant impact on the outcome of patients with ICUAP. Patients at risk from persistent CVF should be promptly recognized to optimize treatment and outcomes.
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Caplan M, Duburcq T, Moreau AS, Poissy J, Nseir S, Parmentier-Decrucq E. Hyperbaric hyperoxemia as a risk factor for ventilator-acquired pneumonia? PLoS One 2021; 16:e0253198. [PMID: 34161365 PMCID: PMC8221473 DOI: 10.1371/journal.pone.0253198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/30/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Ventilator-acquired pneumonia (VAP) is the leading cause of serious associated infections in Intensive Care Units (ICU) and is associated with significant morbidity. The use of hyperbaric oxygen therapy (HBOT) in patients on mechanical ventilation may increase exposure to certain risk factors such as hyperoxemia and the need for multiple transfers. The aim of our study was to assess the relationship between HBOT and VAP. METHOD This retrospective observational study was performed from March 2017 to March 2018 in a 10-bed ICU using HBOT. All patients receiving mechanical ventilation (MV) for more than 48 hours were eligible. VAP was defined using clinical and radiological criteria. Data collection was carried out via digital medical records. Risk factors for VAP were determined by univariate and multivariate analysis. RESULTS Forty-two (23%) of the 182 patients enrolled developed at least one episode of VAP. One hundred and twenty-four (68%) patients received HBOT. The incidence rate of VAP was 34 per 1000 ventilator days. The occurrence of VAP was significantly associated with immunosuppression (p<0.029), MV duration (5 [3-7] vs 8 [5-11.5] days, p<0.0001), length of stay (8 [5-13] vs 19.5 [13-32] days, p<0.0001), reintubation (p<0.0001), intra-hospital transport (p = 0.001), use of paralytic agents (p = 0.013), tracheotomy (p = 0.003) and prone position (p = 0.003). The use of HBOT was not associated with the occurrence of VAP. Multivariate analysis identified reintubation (OR: 8.3 [2.6-26.6]; p<0.0001), intra-hospital transport (OR: 3.5 [1.3-9.2]; p = 0.011) and the use of paralytic agents (OR: 3.3 [1.3-8.4]; p = 0.014) as independent risk factors for VAP. CONCLUSION Known risk factors for VAP are to be found within our ICU population. HBOT, however, is not an extra risk factor for VAP within this group. Further experimental and clinical investigations are needed to understand the impact of HBOT on the occurrence of VAP and on physiological microbiome.
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Affiliation(s)
- Morgan Caplan
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
| | - Thibault Duburcq
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
| | - Anne-Sophie Moreau
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
| | - Julien Poissy
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
| | - Saad Nseir
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, Lille, France
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