Ventilator-Associated Pneumonia in Patients with SARS-CoV-2–Associated Acute Respiratory Failure Requiring Mechanical Ventilation: A Retrospective Cohort Study

Abstract Background. Data on incidence, clinical presentation and outcomes of ventilator-associated pneumonia (VAP) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia requiring mechanical ventilation (MV) are limited.Methods. Case series of patients with COVID-19 pneumonia admitted to a single ICU in France. All consecutive patients requiring MV with RT-PCR–confirmed SARS-CoV-2 infection between March 12th and April 24th, 2020 were included. Frequency, clinical characteristics, responsible pathogens and outcomes of VAP were assessed, and compared to an historical cohort of patients with severe influenza-associated pneumonia requiring MV admitted to the same ICU during the preceding three winter seasons.Results: Among 54 consecutive patients with Covid-19–associated acute respiratory failure requiring MV included (median (IQR) age 48 (42-58) years; 74% male; 93% requiring venovenous-extracorporeal membrane oxygenation), 46 (85%) developed VAP (median (IQR) MV duration before the first episode, 11 (8-16) days). VAP-causative pathogens were predominantly Enterobacteriaceae (72%), particularly inducible AmpC-cephalosporinase producers (41%), followed by Pseudomonas aeruginosa (35%). VAP recurred in 46 (85%) patients and 17 (31%) died. Most recurrences were relapses (ie, infection with the same pathogen), with a high percentage occurring on adequate antimicrobial treatment. Despite a high P. aeruginosa-VAP rate in patients with influenza-associated ARDS, the pulmonary infection recurrence rate was significantly lower than in Covid-19 patients. Overall mortality was similar for the two groups.Conclusions: Patients with severe Covid-19–associated acute respiratory failure requiring MV had a very high late-onset VAP rate. Inducible AmpC-cephalosporinase–producing Enterobacteriaceae and Pseudomonas aeruginosa frequently caused VAP, with multiple recurrences and difficulties eradicating the pathogen from the lung.