Incidence, microbiological and immunological characteristics of ventilator-associated pneumonia assessed by bronchoalveolar lavage and endotracheal aspirate in a prospective cohort of COVID-19 patients: CoV-AP study
Authors' conclusion
In COVID-19 ICU patients, differences in microbial sampling at VAP suspicion could lead to high variability in VAP incidence and microbiological findings.
Study context
- Population
- Mechanically ventilated COVID-19 patients, Policlinico Hospital (Milan, Italy), January 2021 to May 2022
- Participants
- 79 participants
- Exposure
- Endotracheal aspirates (ETA) and BALFAPPP vs bronchoalveolar lavage (BAL) (reference standard) for microbiological confirmation of suspected ventilator-associated pneumonia (VAP)
- Outcome
- Incidence of microbiologically confirmed VAP by respiratory sample (ETA vs BAL)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Incidence rate of microbiologically confirmed VAP
ETA
33.1
95% CI 22.1–44.0
BAL
20.1
95% CI 12.5–27.7
Observational data: associations, not effects.
Further findings
| Outcome | ETA | BALFAPPP | P value |
|---|---|---|---|
| Diagnostic accuracy vs BAL (reference standard) | |||
| Concordance with BAL | 35/49 (71.4%) | 39/49 (79.6%) | |
| Sensitivity | 88.9% (95% CI 70.8-97.7) | 95.0% (95% CI 75.1-99.9) | |
| Specificity | 50.0% (95% CI 28.2-71.8) | 69% (95% CI 49.2-84.7) | |
| Cohen's Kappa | 0.40 (95% CI 0.16-0.65) | 0.60 (95% CI 0.39-0.81) | |
| BAL IL-1βVAP vs no-VAP · differed significantly | P = 0.03 |
- BAL IL-1β: VAP 135 (IQR 11–450) pg/ml
- BAL IL-1β: no-VAP 10 (IQR 2.9–105) pg/ml
Original publication
Incidence, microbiological and immunological characteristics of ventilator-associated pneumonia assessed by bronchoalveolar lavage and endotracheal aspirate in a prospective cohort of COVID-19 patients: CoV-AP study. Crit Care. Published 26 September 2023. doi:10.
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