The infection characteristics of COVID-19 complicated by ventilator-associated pneumonia
Objective To investigate the incidence,risk factors and pathogen spectrum of ventilator-associated pneumonia(VAP)in coronavirus disease 2019(COVID-19)patients undergoing mechanical ventilation(MV).Methods The clinical data and etiological examination results of 733 patients admitted to a general hospital in Shenzhen who were treated with MV from October 1,2022 to September 30,2023 were retrospectively analyzed.Patients eligible for the diagnosis of novel coronavirus were classified as Cov group(n=1 12),and other patients infected with non-novel coronavirus were classified as n-Cov group(n=621).Cov with VAP is Cov-VAP group(n=37),n-Cov with VAP is n-Cov-VAP group(n=95).Results The proportions of underlying diseases such as renal insufficiency,chronic kidney disease,coronary heart disease,heart failure/cardiac insufficiency,respiratory failure,and anemia in the Cov group were 23.2％(26/112),9.8％(11/112),16.1％(18/112),19.6％(22/112),40.2％(45/112),and 35.7％(40/112),respectively,which were significantly higher than those in n-Cov group,the differences were statistically significant(x2=9.189,4.881,4.357,14.981,63.312,17.630,all P＜0.05).The proportions of diabetes mellitus and heart failure/cardiac insufficiency among the Cov-VAP group were 48.6％(18/37)and 24.3％(9/37),respectively,which were significantly higher than those of the n-Cov-VAP group,the differences were statistically significant(x2=11.843,6.002,all P＜0.05).The mortality of the Cov-VAP group(43.2％,16/37)was significantly higher than that of the n-Cov-VAP group(22.1％,21/95),the differences was statistically significant(x2=5.898,P＜0.05).A total of 25 strains of microorganisms were isolated from respiratory specimens in the COV-VAP group,and the main pathogens were Acinetobacter baumannii(6),Pseudomonas aeruginosa(4),Klebsiella pneumoniae(4),and Stenotrophomonas maltophila(4).Twenty-seven strains of pathogenic bacteria were isolated from respiratory specimens in the non-COVID-19 with VAP group,and the main pathogens were S.maltophila(9),P.aeruginosa(7),and K pneumoniae(6).A.baumannii was not isolated from the COVID-19 with VAP group.Conclusions A high morbidity and mortality of VAP was seen in patients undergoing MV,and elder age,underlying diseases including renal insufficiency and coronary heart disease were the high-risk factors.Gram-negative bacteria were the commonly identified pathogens.
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