Respiratory failure & ventilation
Risk factors for ventilator‐associated lower respiratory tract infection in COVID‐19, a retrospective multicenter cohort study in Sweden
Authors' conclusion
We report a high incidence of culture-verified VA-LRTI in a cohort of critically ill COVID-19 patients from the first three pandemic waves. VA-LRTI was associated with increased morbidity but not 30-, 60-, or 90-day mortality. Corticosteroid treatment, antibiotics at intubation and time on IMV were associated with increased aOR of first VA-LRTI.
Study context
- Population
- Patients admitted to 10 intensive care unit (ICUs) in southeast Sweden (March 1, 2020–May 31, 2021) with acute hypoxemic respiratory failure due to COVID-19, mechanically ventilated ≥48 h
- Participants
- 536 patients · 10 ICUs
- Exposure
- Ventilator-associated lower respiratory tract infections (VA-LRTI) vs no VA-LRTI
- VA-LRTIn = 153
- Outcome
- Culture verified VA-LRTI
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
VA-LRTI
28.5%
153
- Incidence rate of first VA-LRTI per 1000 days of invasive mechanical ventilation (IMV)
- 20.8
Observational data: associations, not effects.
Secondary outcomes
Risk factors for first VA-LRTI (logistic regression)
| aOR (95% CI) | ||
|---|---|---|
| Corticosteroids | 2.64 (1.31–5.74) | |
| Antibiotics at intubation | 2.01 (1.14–3.66) | |
| 0.20.5125Adjusted odds ratio (log scale) |
| Outcome | aOR (95% CI) | |
|---|---|---|
| Risk factors for first VA-LRTI (logistic regression)Days of IMV · per day of IMV | 1.05 (1.03–1.07) | |
| 0.512Adjusted odds ratio (log scale) |
Mortality, age, sex, number of comorbidities
- No differences between VA-LRTI and no VA-LRTI
Clinical course
- VA-LRTI: fewer ventilator-free days, longer ICU stay, more prone ventilation, more corticosteroids, more often on antibiotics at intubation
Incidence of VA-LRTI by pandemic wave (per 1000 days of IMV)
- First wave
- 14.5
- Subsequent waves
- 24.8
Microbiology
- Few multidrug-resistant pathogens identified
Original publication
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