In-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay
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Abstract
Introduction: patients with COVID-19 are more likely to require mechanical ventilation, which increases the risk of ventilator-associated pneumonia (VAP), mortality rates, length of stay in intensive care units (ICUs), and healthcare costs.
Objective: to determine the in-hospital mortality of patients with COVID-19 complicated by bacterial pneumonia on mechanical ventilation in Adult Intensive Care in a Hospital in Paraguay during the years 2020 to 2021.
Methodology: this is a retrospective cohort analytical study. Demographic variables, comorbidities, severity scores such as APACHE II on admission, the worst oxygenation during hospitalization expressed by PaO2/FiO2, days of ventilation, prone position, tracheostomy, pharmacological and non-pharmacological therapeutic measures, days of hospitalization, as well as complications and mortality were recorded.
Results: a total of 214 patients were included, 135 were admitted to mechanical ventilation (MRA), of which 58 (42.9 %) developed VAP, with a median age of 52 years (40-60). VAP microorganisms were Gram-negative cocci in 98.3 %, including Acinetobacter baumanii in 46.5 %, Klebsiella pneumoniae in 22.8 %, Pseudomona aeruginosa in 15.5 %, and Stenotrophomona maltophilia in
5.2%. In-hospital mortality was 44.8 %. Those under 50 years of age have a longer survival than those older (34 days vs. 22 days, with p of 0.026).
Conclusion: the overall mortality rate was 44.8%. Age was an independent risk factor for mortality in patients with VAP, so healthcare professionals should be aware of the possibility of VAP in patients who require mechanical ventilation, especially in patients over 50 years of age.
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References
Russo A, Olivadese V, Trecarichi EM, Torti C. Bacterial ventilator-associated pneumonia in COVID-19 patients: data from the second and third waves of the pandemic. J. Clin. Med. 2022;11(9):2279: 2-16. doi: 10.3390/jcm11092279 .
Velásquez-Garcia L, Mejia-Sanjuanelo A, Viasus D, Carratalà J. Causative agents of ventilatorassociated pneumonia and resistance to antibiotics in COVID-19 patients: a systematic review. Biomedicines. 2022; 10(6):1226. doi: 10.3390/biomedicines10061226.
Pickens CO, Gao CA, Cuttica MJ, Smith SB, Pesce LL, Grant RA, et al. Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia. Am J Respir Crit Care Med. 2021;204(8):921-932. doi: 10.1164/rccm.202106-1354OC.
Weinberger J, Rhee Ch, Klompas M. Incidence, characteristics, and outcomes of ventilatorassociated events during the covid-19 pandemic. Ann Am Thorac Soc. 2022;19(1):82-89. doi: 10.1513/AnnalsATS.202103-364OC.
Figueredo B, Samudio M, Fretes F , Delgado R , Ibarra D , Pederzani M, et al. Factores asociados a mortalidad en pacientes críticos con COVID-19 en un centro universitario de Paraguay. Rev Chilena Infectol. 2023;40(3):257-264. doi: 10.4067/s0716-10182023000300257
Laurichesse G , Schwebel C , Buetti N, Neuville M , Siami S , Cohen Y , et al. Mortality, incidence, and microbiological documentation of ventilated acquired pneumonia (VAP) in critically ill patients with COVID-19 or infuenza. Annals of Intensive Care. 2023;13(108): 2-13. doi:10.1186/s13613-023-01207-9
Li G, Cook D, Thabane L, Friedrich J, Crozier T , Muscedere J, et al. Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respiratory Research. 2016;17(80): 2-9. doi: 10.1186%2Fs12931-016-0397-5
Cour M , Simon M, Argaud L, Monneret G, Venet F. Efects of dexamethasone on immune dysfunction and ventilator-associated pneumonia in COVID-19 acute respiratory distress syndrome: an observational study. J Intensive Care. 2021; 9(64): 2-4. doi: 10.1186/s40560-021-00580-6
Carbonell R, Silvia Urgel S, Alejandro Rodríguez A, Bodí M, Martín-Loeches I, Solé-Violan J, et al. Mortality comparison between the first and second/ third waves among 3,795 critical COVID19 patients with pneumonia admitted to the ICU: a multicentre retrospective cohort study. Lancet Reg Health Eur. 2021;11:100243. doi :10.1016/j.lanepe.2021.100243
Karmen-Tuohy S, Carlucci PM, Zervou FN, Zacharioudakis IM, Rebick G, Klein E, et al. Outcomes among HIV-positive patients hospitalized with COVID-19. J Acquir Immune Defic Syndr. 2020;85(1):6-10. doi: org/10.1097/qai.0000000000002423
Mahida RY, Chotalia M, Alderman J, Patel C, Hayden A, Desai R, et al. Characterisation and outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: a singlecentre experience. BMJ Open Respir Res. 2020;7(1):e000731. doi: 10.1136/bmjresp-2020-000731.
Fakhreddine S, Fawaz M, Hassanein S, Al Khatib A. Prevalence and mortality rate of healthcareassociated infections among COVID-19 patients: a retrospective cohort community-based approach. Front Public Health. 2023;11:1235636. doi: 10.3389/fpubh.2023.1235636.
Moretti M, Van Laethem J, Minini A, Pierard D, Malbrain MLNG. Ventilator-associated bacterial pneumonia in coronavirus 2019 disease, a retrospective monocentric cohort study. J Infect Chemother. 2021;27(6):826-833. doi: 10.1016/j.jiac.2021.01.011.
Gregorczyk-Maga I, Pałka A, Fiema M, Kania M, Kujawska A, Maga P, et al. Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: an intervention study. Antimicrob Resist Infect Control. 2023;12(1):17. doi: 10.1186/s13756-023-01218-y
Cini C, Neto AS, Burrell A, Udy A; SPRINT-SARI Australia investigators. Inter-hospital transfer and clinical outcomes for people with COVID-19 admitted to intensive care units in Australia: an observational cohort study. Med J Aust. 2023;218(10):474-481. doi: 10.5694/mja2.51917.
Szabó BG, Czél E, Nagy I, Korózs D, Petrik B, Marosi B, et al. Clinical and microbiological outcomes and follow-up of secondary bacterial and fungal infections among critically Ill COVID-19 adult patients treated with and without immunomodulation: a prospective cohort study. Antibiotics (Basel). 2023;12(7):1196. doi: 10.3390/antibiotics12071196