Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study
Abstract Background The management of severe SARS-CoV-2 pneumonia, alongside logistical constraints, evolved between the first and subsequent COVID-19 waves. This study aimed to compare the prevalence of early bacterial pulmonary co-infections and the incidence of ventilator-associated lower respira...
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2025-03-01
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| author | Anahita Rouze Pedro Povoa Ignacio Martin-Loeches Ouriel Saura Julien Maizel Olivier Pouly Demosthenes Makris Damien Du Cheyron Fabienne Tamion Marie Labruyere Laurent Argaud Fabien Lambiotte Elie Azoulay Martine Nyunga Matthieu Turpin Mehdi Imouloudene Nicolas Weiss Arnaud W. Thille Bruno Megarbane Eleni Magira Iliana Ioannidou Gaëtan Plantefeve Flavia Galli Emili Diaz Armand Mekontso Dessap Pierre Asfar Alexandre Boyer Alexandra Beurton Ariane Gavaud Charlotte Larrat Jean Reignier Alexandre Pierre Christophe Vinsonneau Pierre-Edouard Floch Adrian Ceccato Antonio Artigas Alexandre Iellatchitch Julien Labreuche Saad Nseir the coVAPid study group |
| author_facet | Anahita Rouze Pedro Povoa Ignacio Martin-Loeches Ouriel Saura Julien Maizel Olivier Pouly Demosthenes Makris Damien Du Cheyron Fabienne Tamion Marie Labruyere Laurent Argaud Fabien Lambiotte Elie Azoulay Martine Nyunga Matthieu Turpin Mehdi Imouloudene Nicolas Weiss Arnaud W. Thille Bruno Megarbane Eleni Magira Iliana Ioannidou Gaëtan Plantefeve Flavia Galli Emili Diaz Armand Mekontso Dessap Pierre Asfar Alexandre Boyer Alexandra Beurton Ariane Gavaud Charlotte Larrat Jean Reignier Alexandre Pierre Christophe Vinsonneau Pierre-Edouard Floch Adrian Ceccato Antonio Artigas Alexandre Iellatchitch Julien Labreuche Saad Nseir the coVAPid study group |
| author_sort | Anahita Rouze |
| collection | DOAJ |
| description | Abstract Background The management of severe SARS-CoV-2 pneumonia, alongside logistical constraints, evolved between the first and subsequent COVID-19 waves. This study aimed to compare the prevalence of early bacterial pulmonary co-infections and the incidence of ventilator-associated lower respiratory tract infections (VA-LRTI) across the first and second waves of the pandemic, and to characterize their microbiology. Methods Latter part of a multicenter retrospective European cohort analysis conducted in 35 ICUs. Adult patients admitted for SARS-CoV-2 pneumonia and requiring invasive mechanical ventilation ≥ 48 h were consecutively included from both waves (February-May 2020 for period 1, October 2020-April 2021 for period 2). Co-infections were defined by bacterial isolation in respiratory secretions or blood cultures, or a positive pneumococcal urinary antigen test, within 48 h after intubation. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. The 28-day cumulative incidence of first VA-LRTI episodes was estimated using the Kalbfleisch and Prentice method, with co-infection prevalence and VA-LRTI incidence compared using multivariable logistic regression and Fine-and-Gray models, respectively. Results The study included 1,154 patients (558 in period 1 and 596 in period 2). Co-infection prevalence significantly rose from 9.7% in period 1 to 14.9% in period 2 (adjusted odds ratio (95% confidence interval) 1.52 (1.04–2.22), p = 0.03). Gram-positive cocci dropped from 59 to 48% of co-infections between periods 1 and 2. The overall incidence of VA-LRTI was similar across periods (50.4% and 53.9%, adjusted sub distribution hazard ratio (sHR) 1.14 (0.96–1.35), p = 0.11), with a significant increase in VAP incidence in period 2 (36% to 44.8%, adjusted sHR 1.37 (1.12–1.66), p = 0.001), predominantly occurring within the initial 14 days after intubation, and a concurrent significant decrease in VAT incidence (14.3% to 9.1%, adjusted sHR 0.61 (0.42–0.88), p = 0.007). Gram-negative bacilli, led by Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp., were responsible for 89% and 84% of VA-LRTI in periods 1 and 2, respectively. Conclusions Between the first and second COVID-19 waves, the prevalence of early bacterial pulmonary co-infections significantly increased among intubated patients. Although the overall incidence of VA-LRTI remained stable, there was a significant shift from VAT to VAP episodes. |
| format | Article |
| id | doaj-art-9e43986fe3174e4f92a36d943899b012 |
| institution | OA Journals |
| issn | 1465-993X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
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| series | Respiratory Research |
| spelling | doaj-art-9e43986fe3174e4f92a36d943899b0122025-08-20T01:57:52ZengBMCRespiratory Research1465-993X2025-03-0126111210.1186/s12931-025-03148-2Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort studyAnahita Rouze0Pedro Povoa1Ignacio Martin-Loeches2Ouriel Saura3Julien Maizel4Olivier Pouly5Demosthenes Makris6Damien Du Cheyron7Fabienne Tamion8Marie Labruyere9Laurent Argaud10Fabien Lambiotte11Elie Azoulay12Martine Nyunga13Matthieu Turpin14Mehdi Imouloudene15Nicolas Weiss16Arnaud W. Thille17Bruno Megarbane18Eleni Magira19Iliana Ioannidou20Gaëtan Plantefeve21Flavia Galli22Emili Diaz23Armand Mekontso Dessap24Pierre Asfar25Alexandre Boyer26Alexandra Beurton27Ariane Gavaud28Charlotte Larrat29Jean Reignier30Alexandre Pierre31Christophe Vinsonneau32Pierre-Edouard Floch33Adrian Ceccato34Antonio Artigas35Alexandre Iellatchitch36Julien Labreuche37Saad Nseir38the coVAPid study groupUniv. Lille, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et FonctionnelleDepartment of Intensive Care, Hospital de São Francisco Xavier, CHLODepartment of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s HospitalService de Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique – Hôpitaux de Paris, Groupe Hospitalier Pitié-SalpêtrièreService de Médecine Intensive Réanimation, CHU Amiens PicardieService de Médecine Intensive Réanimation, Hôpital Saint Philibert GHICL, Université CatholiqueIntensive Care Unit, University Hospital of Larissa, University of ThessalyDepartment of Medical Intensive Care, Caen University HospitalMedical Intensive Care Unit, Rouen University Hospital, UNIROUEN, Inserm U1096, FHU- REMOD-VHFDepartment of Intensive Care, François Mitterrand University HospitalService de Médecine Intensive - Réanimation, Hôpital Edouard HerriotService de Réanimation PolyvalenteService de Médecine Intensive Réanimation, Hôpital Saint-LouisService de Réanimation, Centre Hospitalier de RoubaixService de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital TenonService de Réanimation Et de Soins IntensifsSorbonne Université, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital de La Pitié-Salpêtrière, Médecine Intensive Réanimation À Orientation NeurologiqueCIC 1402 ALIVE, CHU de Poitiers, Médecine Intensive Réanimation, Université de PoitiersDepartment of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM, UMRS-1144, Paris Cité UniversityFirst Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Evangelismos HospitalFirst Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Sotiria Chest HospitalService de Réanimation Polyvalente, CH Victor DupouyApplied Research in Respiratory Diseases, Institut d’nvestigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of BarcelonaCritical Care Department, Departament de Medicina, Hospital Universitari Parc Tauli, Sabadell, Universitat Autonoma de BarcelonaAssistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, Université Paris Est Créteil, CARMAS, INSERM U955, Institut Mondor de Recherche BiomédicaleDépartement de Médecine Intensive Réanimation, CHU d’AngersService de Médecine Intensive Réanimation, CHU de BordeauxService de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié SalpêtrièreMedical Intensive Care Unit, Cochin Hospital, Assistance Publique – Hôpitaux de ParisService de Médecine Intensive Réanimation, Hôpital Bretonneau, CHU de ToursService de Médecine Intensive Réanimation, CHU de NantesService de Réanimation Polyvalente, Centre Hospitalier de LensIntensive Care Unit, Hôpital de BéthuneService de Réanimation, Hôpital DuchenneIntensive Care Unit, Hospital Universitari Sagrat CorCritical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, Institut d’Investigació i Innovació Parc Tauli (I3PT-CERCA), CIBER Enfermedades Respiratorias, Autonomous University of BarcelonaCHU LilleUniv. Lille, ULR 2694-METRICS : Evaluation des Technologies de Santé et des Pratiques MédicalesUniv. Lille, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et FonctionnelleAbstract Background The management of severe SARS-CoV-2 pneumonia, alongside logistical constraints, evolved between the first and subsequent COVID-19 waves. This study aimed to compare the prevalence of early bacterial pulmonary co-infections and the incidence of ventilator-associated lower respiratory tract infections (VA-LRTI) across the first and second waves of the pandemic, and to characterize their microbiology. Methods Latter part of a multicenter retrospective European cohort analysis conducted in 35 ICUs. Adult patients admitted for SARS-CoV-2 pneumonia and requiring invasive mechanical ventilation ≥ 48 h were consecutively included from both waves (February-May 2020 for period 1, October 2020-April 2021 for period 2). Co-infections were defined by bacterial isolation in respiratory secretions or blood cultures, or a positive pneumococcal urinary antigen test, within 48 h after intubation. VA-LRTI, including ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP), were diagnosed using clinical, radiological and quantitative microbiological criteria. The 28-day cumulative incidence of first VA-LRTI episodes was estimated using the Kalbfleisch and Prentice method, with co-infection prevalence and VA-LRTI incidence compared using multivariable logistic regression and Fine-and-Gray models, respectively. Results The study included 1,154 patients (558 in period 1 and 596 in period 2). Co-infection prevalence significantly rose from 9.7% in period 1 to 14.9% in period 2 (adjusted odds ratio (95% confidence interval) 1.52 (1.04–2.22), p = 0.03). Gram-positive cocci dropped from 59 to 48% of co-infections between periods 1 and 2. The overall incidence of VA-LRTI was similar across periods (50.4% and 53.9%, adjusted sub distribution hazard ratio (sHR) 1.14 (0.96–1.35), p = 0.11), with a significant increase in VAP incidence in period 2 (36% to 44.8%, adjusted sHR 1.37 (1.12–1.66), p = 0.001), predominantly occurring within the initial 14 days after intubation, and a concurrent significant decrease in VAT incidence (14.3% to 9.1%, adjusted sHR 0.61 (0.42–0.88), p = 0.007). Gram-negative bacilli, led by Pseudomonas aeruginosa, Enterobacter spp., and Klebsiella spp., were responsible for 89% and 84% of VA-LRTI in periods 1 and 2, respectively. Conclusions Between the first and second COVID-19 waves, the prevalence of early bacterial pulmonary co-infections significantly increased among intubated patients. Although the overall incidence of VA-LRTI remained stable, there was a significant shift from VAT to VAP episodes.https://doi.org/10.1186/s12931-025-03148-2SARS-CoV-2COVID-19Co-infectionVentilator-associated pneumoniaVentilator-associated tracheobronchitisIntensive care |
| spellingShingle | Anahita Rouze Pedro Povoa Ignacio Martin-Loeches Ouriel Saura Julien Maizel Olivier Pouly Demosthenes Makris Damien Du Cheyron Fabienne Tamion Marie Labruyere Laurent Argaud Fabien Lambiotte Elie Azoulay Martine Nyunga Matthieu Turpin Mehdi Imouloudene Nicolas Weiss Arnaud W. Thille Bruno Megarbane Eleni Magira Iliana Ioannidou Gaëtan Plantefeve Flavia Galli Emili Diaz Armand Mekontso Dessap Pierre Asfar Alexandre Boyer Alexandra Beurton Ariane Gavaud Charlotte Larrat Jean Reignier Alexandre Pierre Christophe Vinsonneau Pierre-Edouard Floch Adrian Ceccato Antonio Artigas Alexandre Iellatchitch Julien Labreuche Saad Nseir the coVAPid study group Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study Respiratory Research SARS-CoV-2 COVID-19 Co-infection Ventilator-associated pneumonia Ventilator-associated tracheobronchitis Intensive care |
| title | Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study |
| title_full | Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study |
| title_fullStr | Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study |
| title_full_unstemmed | Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study |
| title_short | Early bacterial co-infections and ventilator-associated lower respiratory tract infections among intubated patients during the first and second COVID-19 waves: a European comparative cohort study |
| title_sort | early bacterial co infections and ventilator associated lower respiratory tract infections among intubated patients during the first and second covid 19 waves a european comparative cohort study |
| topic | SARS-CoV-2 COVID-19 Co-infection Ventilator-associated pneumonia Ventilator-associated tracheobronchitis Intensive care |
| url | https://doi.org/10.1186/s12931-025-03148-2 |
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