Critical Illness, Infections, Organ Failure, Multiple, Septic Shock, Superinfection, Ventilator Associated Pneumonia
Conditions
Brief summary
The COVID-19 pandemic has led to an increased incidence of ventilator-associated pneumonia (VAP) among critically ill patients. However, in a context of high prevalence of multidrug-resistant organisms (MDROs) there is a lack of direct comparison between the incidence of VAP in COVID-19 and non-COVID-19 cohorts. The investigators conducted a prospective, single-center cohort study comparing COVID-19 patients admitted to the intensive care unit (ICU) of the Città della Salute e della Scienza University Hospital in Turin, Italy, between March 2020 and December 2021 (COVID-19 group), with a historical cohort of ICU-mixed patients admitted between June 2016 and March 2018 (NON-COVID-19 group).
Detailed description
The study aims to explore the occurrence and characteristics of ventilator-associated pneumonia (VAP) in critically ill patients during two distinct periods: the pre-pandemic era and the COVID-19 pandemic. VAP, a serious complication arising from invasive mechanical ventilation (IMV) lasting at least 48 hours, had a crude incidence of 5% to 40% before the COVID-19 pandemic, whereas COVID-19 patients experienced even higher rates, reaching 48-64%. The COVID-19 pandemic triggered an unprecedented rise in ICU admissions due to severe acute respiratory syndrome caused by the SARS-CoV-2 virus, leading to a considerable number of patients requiring IMV. Mechanical ventilation is a known risk factor for VAP, and COVID-19 exacerbates this risk due to factors like disease-induced immunoparalysis, prolonged mechanical ventilation and sedation, and more frequent application of prone positioning. Despite the widespread need for prolonged mechanical ventilation in COVID-19 patients, few studies have compared the impact of VAP between pre-pandemic and COVID-19 populations. Additionally, limited research exists on the risk factors for VAP development in COVID-19 patients and the use of scoring systems like SAPS and SOFA as prognostic factors in this specific context. Although the coVAPid study offered insights into VAP risk factors in COVID-19 patients compared to those with influenza, it inadequately addressed the prevalence of multidrug-resistant organisms (MDROs) in this population, particularly carbapenem-resistant Acinetobacter baumannii (CR-Ab). Hence, this study aims to bridge this knowledge gap by investigating VAP's impact in a setting characterized by a high incidence of multidrug resistance. To achieve this, the study will take place at the Molinette Hospital of the Città della Salute e della Scienza University Hospital in Turin, Italy, over a six-year period, spanning from January 2016 to December 2022. This retrospective, observational, and monocentric study will focus on two distinct cohorts: the pre-pandemic cohort (NON-COVID-19) and the COVID-19 cohort. Researchers will identify ventilator-associated pneumonia (VAP) episodes based on the current definitions provided by the European Center for Disease Prevention and Control (ECDC). Patients will be monitored until hospital discharge to assess outcomes, including ICU mortality, overall mortality, duration of ICU stay, and duration of hospitalization.
Interventions
OTHERCOVID-19
The investigators stratified our population based on COVID-19 virus positivity to identify any risk factors in this population compared to the NON-COVID-19 population.
Sponsors
University of Turin, Italy
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All adult patients diagnosed with ventilator-associated pneumonia * Patients admitted to the intensive care units * Patients who underwent mechanical ventilation for a duration longer than 48 hours
Exclusion criteria
* Patients in extreme end-of-life conditions * Pregnant individuals * Patients under 18 years of age * Patients who did not meet the diagnosis criteria for ventilator-associated pneumonia * Patients who underwent mechanical ventilation for a duration equal to or shorter than 48 hours * Ventilator-associated tracheobronchitis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | 28 days | Mortality within the first 28 days from ICU admission |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital mortality | From date of enrollment until the date of hospital discharge, assessed up to 6 months | Mortality during hospital stay |
| Mechanical ventilation days | From date of enrollment until the date of intensive care unit discharge, assessed up to 6 months | Days of mechanical ventilation length of stay |
| Ventilator acquired pneumonia incidence | From date of enrollment until the date of intensive care unit discharge, assessed up to 6 months | Incidence of ventilator acquired pneumonia |
| ICU mortality | From date of enrollment until the date of intensive care unit discharge, assessed up to 6 months | Mortality during intensive care unit stay |
| Difficult to treat pathogens incidence | From date of enrollment until the date of intensive care unit discharge, assessed up to 6 months | Incidence of difficult to treat pathogens |
| Hospital length of stay | From date of enrollment until the date of hospital discharge, assessed up to 6 months | Duration of hospital length of stay |
| Intensive care unit length of stay | From date of enrollment until the date of intensive care unit discharge, assessed up to 6 months | Duration of intensive care unit length of stay |
| Multidrug-resistant micro-organisms incidence | From date of enrollment until the date of intensive care unit discharge, assessed up to 6 months | Incidence of Multidrug-resistant micro-organisms |
Countries
Italy
Outcome results
None listed