Recurrent ventilator-associated pneumonia in severe Covid-19 ARDS patients requiring extracorporeal membrane oxygenation (ECMO) support
Authors' conclusion
In patients with severe Covid-19-ARDS requiring ECMO support, VAP recurrence occurs frequently, with Enterobacteriaceae and Pseudomonas aeruginosa as predominant causative microorganisms. An antimicrobial treatment of ≥ 8 days for the treatment of first VAP episode did not reduce the risk of VAP recurrence, as compared to shorter duration.
Study context
- Population
- Adults with COVID-19 severe pneumonia on ECMO, March 2020–January 2022210 with first ventilator-associated pneumonia (VAP) analysed
- Participants
- 252 adults
- Exposure
- Short vs prolonged antimicrobial treatment of first VAP
- Short coursen = 158reference
- Prolonged coursen = 52
- Outcome
- Incidence of VAP recurrence
Main finding
As reported in the abstract
VAP recurrence, patients with first VAP (n = 210)
172
82%
Median (IQR) time from first VAP to recurrence, days
10
7–13
Observational data: associations, not effects.
Secondary outcomes
VAP recurrence by antimicrobial duration for first VAP: short course (<8 days) vs prolonged course (≥8 days) · death and extubation as competing risks
Median (IQR) duration, days Short course 6 (5-7) · Prolonged course 9 (8-10)
VAP recurrence by antimicrobial duration for first VAP: short course (<8 days) vs prolonged course (≥8 days)
- Estimated cumulative incidence of VAP recurrence not different between short and prolonged course
First VAP
- First VAP among included patients (n = 252)
- 226 (90%)
Causative microorganisms
- Pseudomonas aeruginosa, first VAP
- 28%
- Enterobacteriaceae, first VAP
- 52%
- Pseudomonas aeruginosa, first recurrence
- 51%
- Enterobacteriaceae, first recurrence
- 62%
Original publication
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