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. 2022 Dec 1;30(4):570–576. doi: 10.53854/liim-3004-12

Table 1.

Characteristics of included studies on ventilator-associated pneumonia in COVID-19.

Population Time to VAP diagnosis
Median (Range) in days 		Demographic characteristics/Risk factors Sample methods Microbiology Outcomes Early appropriate treatment
Giacobbe et al. [7]

  • - 171 patients (29% of the general population)

  • - Median age 64 (57–71) years

  • - 80% (Male)

 9 (5–15)
18 per 1000 ventilator days

  • - Hypertension (64%)

  • - DM (23%)

  • - Previous antibiotics (95%)

  • - Previous steroids (63%)

  • - Previous anti-IL-6 (64%)

 BAL 77 (45%)

  • - P. aeruginosa (35%)

  • - MSSA (23%)

  • - K. pneumoniae (19%)

  • - MRSA (10%)

  • - CRE (32%)

 30-day case-fatality 46%
Risk factors for mortality: septic shock at VAP onset (OR 3.30)
ARDS at VAP onset (OR 13.21)		 45/77 cases (58%)
Not protective in mortality
Llitjos at al. [8]

  • - 92 patients (52%)

  • - Median age 63 (55–73) years

  • - 76% (Male)

 9 (6–14)

  • - DM (26%)

  • - COPD (10%)

  • - Immunosuppression (15%)

  • - Septic shock at VAP onset (16%)

  • - ARDS (96%, SHR=1.84)

  • - Duration of MV (SHR=1.027)

 ETA or BAL, not specified

  • - Enterobacteriaceae (50%)

  • - Non-fermenting GNB (20%)

  • - Gram-positive cocci (28%)

  • - Polymicrobial (24%)

 ICU length of stay, days 20 (12–30)
ICU mortality 31%		 NA
Luyt et al. [9]

  • - 43 patients (86%) in ECMO

  • - Median age 48 (42–56) years

  • - 72% (Male)

 10 (8–16)

  • - VAP recurrence rate 79%

 Quantitative growth (≥104 CFU/mL)
BAL

  • - Enterobacteriaceae (70%)

  • - Inducible AmpC-cephalosporinase producers (40%)

  • - Non-fermenting GNB (42%) inc. P. aeruginosa (37%)

  • - Polymicrobial (38%)

 ECMO support, days 21 (10–34)
Days on MV 45 (27–62) ICU length of stay, days 48 (34–68)
ICU mortality rate, days 17 (34)		 81%
Razazi et al. [10]

  • - 58 patients (64%)

 8 (5–12)

  • - Recurrent VAP 22 (25%) vs 10 (12%) in NC-ARDS p=ns

 Blind protected telescope catheter 89%
BAL 11%

  • - MDR-VAP in C-ARDS vs NC-ARDS: 21 (23%) vs. 9 (11%), p=0.03.

  • - ESBL VAP in NC-ARDS vs C-ARDS: 9 (11%) vs 18 (20%)

  • - MRSA VAP in NC-ARDS vs C-ARDS: 0 vs 1 (1%)

 -- Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p<0.01
Rouzé et al. [11]

  • - 205 patients (36.1%)

 NA

  • - CPIS 6 (5–7)

  • - PaO2/FiO2 135 (92–180)

  • - SOFA score 8 (5–11)

 ETA 125/205 (61.6%)
BAL 78/205 (38.4%)

  • - GNB (83.6%) inc. P. aeruginosa 64 (22.3%), Enterobacter 54 (18.8%)

  • - MDR isolates 67 (23.3%)

  • - Gram-pos cocci 56 (19.5%)

  • - Polymicrobial 28 (9.8%)

 ICU length of stay, days 18 (12–27)
ICU mortality 164/568 (28.9%)
28-day mortality
166/568 (29.2%)		 145/200 (72.5%)
Maes et al. [12]

  • - 64 patients (79%)

  • - Median age 62 (50–70) years

 28/1000 ventilator days versus vs 13/1000 for pts not COVID (p=0.009)

  • - Hypertension (33%)

  • - DM (22%)

  • - Obesity (37%)

  • - Chronic lung disease (20%)

  • - Immunocompromised (15%)

  • - APACHE II (IQR) 15 (11–19)

  • - ARDS on ICU admission (78%)

 ETA or BAL 39 (48%)
BAL 30 (47%)

  • - E. coli

  • - P. aeruginosa

  • - S. maltophilia

  • - E. cloacae

  • - K. aerogenes

  • - K. pneumoniae

  • - S. aureus

 ICU mortality 31 (38%)
Median length of stay for patients dying in ICU (IQR) 13 (10–17)		 NA
Blonz et al. [13]

  • - 92 patients (48.9%)

  • - Mean age 65.3 (±9.5)

  • - 39.0 per 1000 days MV (until the first VAP episode)

  • - 33 VAP per 1000 days MV (including all 141 episodes of VAP).

  • - BSI (10.6%)

  • - Thoracic empyema (3.5%)

  • - Pulmonary abscess (1.4%)

  • - Male gender (SHR 2.24)

  • - ECMO (15.2%) (SHR 3.09)

  • - Recurrent VAP 37 (19.7%)

 ETA 60 (42.6%), (BAL) 50 (35.4%) plugged telescopic catheter 30 (21.3%)

  • - Polimicrobial 39.0%

  • - Enterobacteria 49.8%

  • - P. aeruginosa 15.1%

  • - GPB in early VAP 47.0% vs 22.8% in late VAP

  • - GNB in late VAP 77.2%

 Still in ICU 3 (5.8) VAP single episode vs 10 (25.0)
VAP multiple episodes (p=0.009)		 69 (89.9%)

Abbreviations: BAL: bronchoalveolar lavage; MSSA: methicillin susceptible Staphylococcus aureus; CRE: carbapenems resistant Enterobacterales; MRSA: methicillin resistant Staphylococcus aureus; ARDS: acute respiratory distress syndrome; VAP: ventilator associated pneumonia; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; MV: mechanical ventilation; ETA: endotracheal aspiration; GNB: Gram negative bacteria; ECMO: extracorporeal continuous membrane oxygenation; NC: not-COVID-19; C: COVID-19; MDR: multi-drug resistant; NA: not applicable.