Risk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study

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dc.contributor.authorReyes, Luis Felipe
dc.contributor.authorRodriguez, Alejandro
dc.contributor.authorFuentes, Yuli V.
dc.contributor.authorDuque, Sara
dc.contributor.authorGarcia-Gallo, Esteban
dc.contributor.authorBastidas, Alirio
dc.contributor.authorSerrano-Mayorga, Cristian C.
dc.contributor.authorIbanez-Prada, Elsa D.
dc.contributor.authorMoreno, Gerard
dc.contributor.authorRamirez-Valbuena, Paula C.
dc.contributor.authorOspina-Tascon, Gustavo
dc.contributor.authorHernandez, Glenn
dc.contributor.authorSilva, Edwin
dc.contributor.authorDiaz, Ana Maria
dc.contributor.authorJibaja, Manuel
dc.contributor.authorVera-Alarcon, Magdalena
dc.contributor.authorDiaz, Emili
dc.contributor.authorBodi, Maria
dc.contributor.authorSole-Violan, Jordi
dc.contributor.authorFerrer, Ricard
dc.contributor.authorAlbaya-Moreno, Antonio
dc.contributor.authorSocias, Lorenzo
dc.contributor.authorFigueroa, William
dc.contributor.authorLozano-Villanueva, Jose L.
dc.contributor.authorVaron-Vega, Fabio
dc.contributor.authorEstella, Angel
dc.contributor.authorLoza-Vazquez, Ana
dc.contributor.authorJorge-Garcia, Ruth
dc.contributor.authorSancho, Isabel
dc.contributor.authorShankar-Hari, Manu
dc.contributor.authorMartin-Loeches, Ignacio
dc.date.accessioned2024-01-10T12:37:18Z
dc.date.available2024-01-10T12:37:18Z
dc.date.issued2023
dc.description.abstractAround one-third of patients diagnosed with COVID-19 develop a severe illness that requires admission to the Intensive Care Unit (ICU). In clinical practice, clinicians have learned that patients admitted to the ICU due to severe COVID-19 frequently develop ventilator-associated lower respiratory tract infections (VA-LRTI). This study aims to describe the clinical characteristics, the factors associated with VA-LRTI, and its impact on clinical outcomes in patients with severe COVID-19. This was a multicentre, observational cohort study conducted in ten countries in Latin America and Europe. We included patients with confirmed rtPCR for SARS-CoV-2 requiring ICU admission and endotracheal intubation. Only patients with a microbiological and clinical diagnosis of VA-LRTI were included. Multivariate Logistic regression analyses and Random Forest were conducted to determine the risk factors for VA-LRTI and its clinical impact in patients with severe COVID-19. In our study cohort of 3287 patients, VA-LRTI was diagnosed in 28.8% [948/3287]. The cumulative incidence of ventilator-associated pneumonia (VAP) was 18.6% [610/3287], followed by ventilator-associated tracheobronchitis (VAT) 10.3% [338/3287]. A total of 1252 bacteria species were isolated. The most frequently isolated pathogens were Pseudomonas aeruginosa (21.2% [266/1252]), followed by Klebsiella pneumoniae (19.1% [239/1252]) and Staphylococcus aureus (15.5% [194/1,252]). The factors independently associated with the development of VA-LRTI were prolonged stay under invasive mechanical ventilation, AKI during ICU stay, and the number of comorbidities. Regarding the clinical impact of VA-LRTI, patients with VAP had an increased risk of hospital mortality (OR [95% CI] of 1.81 [1.40-2.34]), while VAT was not associated with increased hospital mortality (OR [95% CI] of 1.34 [0.98-1.83]). VA-LRTI, often with difficult-to-treat bacteria, is frequent in patients admitted to the ICU due to severe COVID-19 and is associated with worse clinical outcomes, including higher mortality. Identifying risk factors for VA-LRTI might allow the early patient diagnosis to improve clinical outcomes.
dc.fechaingreso.objetodigital2024-04-25
dc.fuente.origenWOS
dc.identifier.doi10.1038/s41598-023-32265-5
dc.identifier.issn2045-2322
dc.identifier.urihttps://doi.org/10.1038/s41598-023-32265-5
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/76809
dc.identifier.wosidWOS:000989734900045
dc.information.autorucFacultad de Medicina; Vera Alarcon, Maria Magdalena; S/I; 226652
dc.issue.numero1
dc.language.isoen
dc.nota.accesocontenido completo
dc.publisherNATURE PORTFOLIO
dc.revistaSCIENTIFIC REPORTS
dc.rightsacceso abierto
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleRisk factors for developing ventilator-associated lower respiratory tract infection in patients with severe COVID-19: a multinational, multicentre study, prospective, observational study
dc.typeartículo
dc.volumen13
sipa.codpersvinculados226652
sipa.indexWOS
sipa.trazabilidadCarga SIPA;09-01-2024
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