Early Bacterial Identification among Intubated Patients with COVID-19 or Influenza Pneumonia: A European Multicenter Comparative Clinical Trial
2 UGSF - Unité de Glycobiologie Structurale et Fonctionnelle - UMR 8576
3 Trinity College Dublin
4 UB - Universitat de Barcelona
5 New University of Lisbon
6 OUH - Odense University Hospital
7 CHU Amiens-Picardie
8 CHU Caen Normandie - CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie
9 Centre hospitalier [Valenciennes, Nord]
10 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
11 CHU Rouen
12 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
13 Centre Hospitalier de Douai [Douai, Nord]
14 Institut de cardiologie [CHU Pitié-Salpêtrière]
15 Centre Hospitalier de Roubaix
16 Hôpital Saint Philibert [Lomme]
17 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
18 CIC 1402 - CIC de Poitiers – Centre d'investigation clinique de Poitiers (CIC 1402)
19 Service de Réanimation Médicale et Toxicologique [Hôpital Lariboisière]
20 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
21 AP-HP - Hopital Saint-Louis [AP-HP]
22 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
23 NKUA - National and Kapodistrian University of Athens
24 Hôpital Cochin [AP-HP]
25 Centre Hospitalier de Lens
26 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
27 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
28 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
29 Hôpital Edouard Herriot [CHU - HCL]
30 CHU Saint-Antoine [AP-HP]
31 CHU Tenon [AP-HP]
32 CH Argenteuil - Centre hospitalier Victor Dupouy [Centre hospitalier d'Argenteuil]
33 CHU Pitié-Salpêtrière [AP-HP]
34 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
35 CHU Angers - Centre Hospitalier Universitaire d'Angers
36 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
37 CHU Henri Mondor [Créteil]
38 CARMAS - Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis)
39 IMRB - Institut Mondor de Recherche Biomédicale
40 University of Thessaly [Larissa]
41 CH Béthune - Centre Hospitalier de Béthune
42 Hôpital Duchenne
43 CRSA - Centre de Recherche Saint-Antoine
44 IDIBAPS - Institut d'Investigacions Biomèdiques August Pi i Sunyer
45 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
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Abstract
Rationale: Early empirical antimicrobial treatment is frequently prescribed to critically ill patients with coronavirus disease (COVID-19) based on Surviving Sepsis Campaign guidelines.Objectives: We aimed to determine the prevalence of early bacterial identification in intubated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia, as compared with influenza pneumonia, and to characterize its microbiology and impact on outcomes.Methods: A multicenter retrospective European cohort was performed in 36 ICUs. All adult patients receiving invasive mechanical ventilation >48 hours were eligible if they had SARS-CoV-2 or influenza pneumonia at ICU admission. Bacterial identification was defined by a positive bacterial culture within 48 hours after intubation in endotracheal aspirates, BAL, blood cultures, or a positive pneumococcal or legionella urinary antigen test.Measurements and Main Results: A total of 1,050 patients were included (568 in SARS-CoV-2 and 482 in influenza groups). The prevalence of bacterial identification was significantly lower in patients with SARS-CoV-2 pneumonia compared with patients with influenza pneumonia (9.7 vs. 33.6%; unadjusted odds ratio, 0.21; 95% confidence interval [CI], 0.15-0.30; adjusted odds ratio, 0.23; 95% CI, 0.16-0.33; P < 0.0001). Gram-positive cocci were responsible for 58% and 72% of coinfection in patients with SARS-CoV-2 and influenza pneumonia, respectively. Bacterial identification was associated with increased adjusted hazard ratio for 28-day mortality in patients with SARS-CoV-2 pneumonia (1.57; 95% CI, 1.01-2.44; P = 0.043). However, no significant difference was found in the heterogeneity of outcomes related to bacterial identification between the two study groups, suggesting that the impact of coinfection on mortality was not different between patients with SARS-CoV-2 and influenza.Conclusions: Bacterial identification within 48 hours after intubation is significantly less frequent in patients with SARS-CoV-2 pneumonia than patients with influenza pneumonia.Clinical trial registered with www.clinicaltrials.gov (NCT04359693).
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