Ventilator-associated pneumonia risk factors in patients with severe COVID-19 in southern Brazil: A retrospective observational study.

BACKGOUND: During the SARS-CoV-2 pandemic, a significant number of critical patients required ventilatory assistance in health institutions. In this context, Ventilator-Associated Pneumonia (VAP) was the most prevalent nosocomial infection among critically ill patients. We aimed to analyze the occurrence of VAP in critically ill patients with SARS-CoV-2 and the risk factors associated with the outcome.

METHOD: This is a multicenter, retrospective cohort study which included patients ≥18 years old, diagnosed with COVID-19, admitted to intensive care units (ICU) and who received invasive mechanical ventilation (MV) for >2 consecutive days. The associations between the variables were initially tested, and those that showed potential associations (p<0.05) were included in the multivariate logistic regression model.

RESULTS

One third of patients had an episode of VAP, with an incidence density of 34.97 cases per 1000 MV days. In addition, 42.37% (50) of the microorganisms causing VAP were multidrug-resistant, predominantly gram-negative bacteria (61.32%). More than 50% of participants developed healthcare-associated infections and 243 (73.64%) died. The factors associated with greater chances of VAP were: prone position (OR= 3.77), BMI 25-29.9 kg/m2 (OR= 4.76), pressure injury (OR= 4.41), length of stay in the ICU (OR= 1.06), positive tracheal aspirate before VAP (OR= 5.41) and dyspnea (OR= 3.80).

CONCLUSIONS

Patients with COVID-19 are at high risk of VAP, which leads to an increased risk of death (OR = 2.18). Multiple factors increase the chances of VAP in this population, namely: work overload in health institutions, prone position, prolonged ICU time, infusion of multiple drugs, invasive devices, and in particular, immobility in bed.