Ventilator-Associated Pneumonia in COVID-19 Patients: Prevalence and Associated Factors
-
Mahdi Bozorgi
,
Mohammad Javad Azadchehr
,
Saina Najafi
,
Najmeh Sedighimehr
,
Javad Fathi
,
Hamed Pahlevani
,
Maedeh Najafizadeh
Abstract
Background: COVID 19 pandemic has resulted in increased ICU admission, with many patients requiring mechanical ventilation resulting in more incidences of ventilator associated pneumonia (VAP). Despite vast research on COVID 19 complications, very few studies have looked at the risk factors of VAP in this population. The purpose of this study is to bridge this gap by identifying clinical and laboratory predictors of VAP in critically ill COVID-19 patients.
Methods: Shahid Beheshti Hospital, Kashan was the site of a retrospective analysis of 235 COVID 19 ICU patients requiring mechanical ventilation. Therapeutic interventions were assessed and clinical symptoms, laboratory markers were assessed.
Results: Fever and chills were also found to be associated with nearly a threefold increase in risk (p < 0.05) as was abnormal heart rate, which increased the risk fourfold (p < 0.001), and WBC and ESR significantly correlated with VAP occurrence. In addition, patients not treated with tocilizumab had a sixfold increase in risk of VAP (p < 0.001). Early identification and targeted interventions to mitigate the risk of VAP in COVID-19 patients being mechanically ventilated is a focus of this study. Conclusion: Results indicate immunomodulatory therapy may provide a protective role, and underscore the importance of strict infection control. Future research should model causal mechanisms and develop best treatment strategies to reduce the incidence of VAP.
1. Yoshimoto FK. The proteins of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2 or n-COV19), the cause of COVID-19. Protein 2020; 39(3):198-216.
2. Rouyer M, Strazzulla A, Youbong T, et al. Ventilator-associated pneumonia in COVID-19 patients: a retrospective cohort study. Antibiotics 2021; 10(8):988.
3. Wu D, Wu C, Zhang S, et al. Risk factors of ventilator-associated pneumonia in critically III patients. Front Pharmacol 2019; 10:482.
4. Turkistani R, Aghashami AS, Badhduoh SS, et al. The Effect of ventilator-associated pneumonia on the time-to-extubation in adult and pediatric intensive care unit patients requiring mechanical ventilation: a retrospective cohort study. Cureus 2024; 16(1):2.
5. Tomaz T, Castro-Vale I. Trauma-informed care in primary health settings—which is even more needed in times of COVID-19. Healthcare (Basel). 2020; 8(3):130-23.
6. Sen S, Johnston C, Greenhalgh D, et al. Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients. J Burn Care Res 2016; 37(3):166-71.
7. Yohannes S, et al, Incidence and Impact of ventilator associated multidrug resistant pneumonia in patients with SARS‐COV2. Crit Care Res Pract 2022; 2022(1):9730895.
8. Renaud C, Kollef MH. Classical and molecular techniques to diagnose HAP/VAP. in Seminars in respiratory and critical care medicine. 2022. Thieme Medical Publishers, Inc.
9. Craven DE, Hudcova J, Lei Y, et al. Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia:“thinking outside the box”. Critical Care 2016.; 20:1-3.
10. Bustos IG, Wiscovitch-Russo R, Singh H, et al. Major alteration of Lung Microbiome and the Host Reaction in critically ill COVID-19 Patients with high viral load. Research Square 2024; 14(1):27637.
11. Deng J, Li F, Zhang N, et al. Prevention and treatment of ventilator-associated pneumonia in COVID-19. Front Pharmacol 2022; 13:945892.
12. Russo A, Olivadese V, Trecarichi EM, et al. Bacterial ventilator-associated pneumonia in COVID-19 patients: data from the second and third waves of the pandemic. J Clin Med 2022; 11(9):2279.
13. Zappella N, Dirani C, Lortat Jacob B, et al. Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre. BMC Anesthesiol 2022; 22(1):310.
14. Martin-Loeches I, Restrepo MI. COVID-19 vs. non-COVID-19 related nosocomial pneumonias: any differences in etiology, prevalence, and mortality? Curr Opin Crit Care 2024; 30(5):463-69.
15. Aissaoui Y, Ennassimi Y, Myatt I, et al. What happened during COVID-19 in African ICUs? An observational study of pulmonary co-infections, superinfections, and mortality in Morocco. PlosOne 2022; 17(12):e0278175.
16. Rangelova V, Kevorkyan A, Raycheva R, et al. Ventilator-associated pneumonia in the neonatal intensive care unit—incidence and strategies for prevention. Diagnostics 2024; 14(3):240.
17. Boe D, Boule L, Kovacs E. Innate immune responses in the ageing lung. Clin Exp Immunol 2017; 187(1):16-25.
18. Whitsett, JA, Alenghat T. Respiratory epithelial cells orchestrate pulmonary innate immunity. Nat immunol 2015 16(1):27-35.
19. Khosla P, Jain K, Taneja V. Cytomegalovirus pneumonia in patients with severe COVID-19. J Assoc Physicians India 2024; 72(8):101-3.
20. Antonacci F, Petroncini M, Salvaterra E, et al. Lung Transplant Recipients and COVID-19: Report of Two Cases. J Clin Med 2023 12(13):4287.
21. Rouzé A, Nseir S. Hospital-acquired pneumonia/ventilator-associated pneumonia and ventilator-associated tracheobronchitis in COVID-19. in seminars in respiratory and critical care medicine. 2022. Thieme Medical Publishers, Inc.
22. Khan W, Safi A, Muneeb M, et al. Complications of invasive mechanical ventilation in critically Ill Covid-19 patients-A narrative review. Ann Med Surg 2022; 80.
23. Molloy EJ, et al, Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Ped Res 2023; 93(6):1499-508.
24. van Duijnhoven M, et al. A predominant cause of recurrence of ventilator-associated pneumonia in patients with COVID-19 are relapses. J Clin Med 2023; 12(18):5821.
25. Lee H, Kang M, Song WO, et al. Gender analysis in the development and validation of FFQ: a systematic review. Brit J Nut 2016; 115(4):666-671.
26. Kortchinsky T, Genty T, Gigandon A, et al. Including organ dysfunctions in a predictive score for nosocomial pneumonia after cardiothoracic surgery. Resp Care 2022; 67(12):1558-67.
27. Sarkkola C, Rounge TB, Simola-Ström S, et al. Validity of home-measured height, weight and waist circumference among adolescents. Eur J Pub Health 2016; 26(6):975-7.
28. Sinnathurai P, Buchbinder R, Hill C, et al. Comorbidity in psoriatic arthritis and rheumatoid arthritis. Int Med J 2018; 48(11):1360-8.
29. Pickens CO, Gao CA, Cuttica MJ, et al. Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia. Am J Resp Crit Care Med 2021; 204(8):921-32.
30. Assimakopoulos SF, et al. N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study. Infec Dis 2021; 53(11):847-854.
31. Lakman IA, Musin TI, Galiullina AR, et al. Risk factors of transfer to mechanical ventilation of COVID-19 patients in a retrospective non-randomized study. Vestn Ross Akad Med Nauk 2022; 77(1):33-42.
32. Solís-Huerta F, Martinez-Guerra BA, Roman-Montes CM, et al. Risk factors associated with the development of hospital-acquired infections in hospitalized patients with severe COVID-19. Antibiotics 2023; 12(7):1108.
33. Silva DHF, Camargos JHd, Rodrigues JG, et al. Impact of oral hygiene in patients undergoing mechanical ventilation in the COVID-19 pandemic. Rev Assoc Med Bras 2020; 66:96-101.
34. Pathak KV, et al. Molecular profiling of innate immune response mechanisms in ventilator-associated pneumonia. Mol Cell Proteomics 2020; 19(10):1688-705.
35. Felten M, et al. Overventilation-induced airspace acidification increases susceptibility to Pseudomonas pneumonia. bioRxiv 2024; 603041.
36. Gholami F, Hamidi Farahani R, Karimi Rahjerdi A, et al. Phase II randomized, double blind, placebo controlled, clinical trial of safety and immunogenicity of an inactivated SARS-CoV-2 vaccine FAKHRAVAC in adults aged 18–70 years. BMC Infect Dis 2023; 23:118.
37. Shoushtari M, Zeinoddini M, Fathi J, et al. One-step and Rapid Identification of SARS-CoV-2 using Real-Time Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP). Avicenna J Med Biotechnol 2024;16(1):3-8.
38. Sedighimehr N, Fathi J, Hadi N, et al. Rehabilitation, a necessity in hospitalized and discharged people infected with COVID-19: a narrative review. Physical Therapy Reviews 2021; 26(3):202-10.
39. Mahjoor M, Askari A, Khaledi M, et al. Relationship between blood groups and the risk of Covid-19 infection; a cohort study. J Med Bacteriol 2024; 12(2):26-33.
40. Khaledi M, Sameni F, Amini-Khoei H, et al. A comprehensive review of herbal recommendations with the potential to inhibit COVID-19 infection. J Med Bacteriol 2023; 11(5, 6):49-69.
2. Rouyer M, Strazzulla A, Youbong T, et al. Ventilator-associated pneumonia in COVID-19 patients: a retrospective cohort study. Antibiotics 2021; 10(8):988.
3. Wu D, Wu C, Zhang S, et al. Risk factors of ventilator-associated pneumonia in critically III patients. Front Pharmacol 2019; 10:482.
4. Turkistani R, Aghashami AS, Badhduoh SS, et al. The Effect of ventilator-associated pneumonia on the time-to-extubation in adult and pediatric intensive care unit patients requiring mechanical ventilation: a retrospective cohort study. Cureus 2024; 16(1):2.
5. Tomaz T, Castro-Vale I. Trauma-informed care in primary health settings—which is even more needed in times of COVID-19. Healthcare (Basel). 2020; 8(3):130-23.
6. Sen S, Johnston C, Greenhalgh D, et al. Ventilator-associated pneumonia prevention bundle significantly reduces the risk of ventilator-associated pneumonia in critically ill burn patients. J Burn Care Res 2016; 37(3):166-71.
7. Yohannes S, et al, Incidence and Impact of ventilator associated multidrug resistant pneumonia in patients with SARS‐COV2. Crit Care Res Pract 2022; 2022(1):9730895.
8. Renaud C, Kollef MH. Classical and molecular techniques to diagnose HAP/VAP. in Seminars in respiratory and critical care medicine. 2022. Thieme Medical Publishers, Inc.
9. Craven DE, Hudcova J, Lei Y, et al. Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia:“thinking outside the box”. Critical Care 2016.; 20:1-3.
10. Bustos IG, Wiscovitch-Russo R, Singh H, et al. Major alteration of Lung Microbiome and the Host Reaction in critically ill COVID-19 Patients with high viral load. Research Square 2024; 14(1):27637.
11. Deng J, Li F, Zhang N, et al. Prevention and treatment of ventilator-associated pneumonia in COVID-19. Front Pharmacol 2022; 13:945892.
12. Russo A, Olivadese V, Trecarichi EM, et al. Bacterial ventilator-associated pneumonia in COVID-19 patients: data from the second and third waves of the pandemic. J Clin Med 2022; 11(9):2279.
13. Zappella N, Dirani C, Lortat Jacob B, et al. Temporary ICUs during the COVID-19 pandemic first wave: description of the cohort at a French centre. BMC Anesthesiol 2022; 22(1):310.
14. Martin-Loeches I, Restrepo MI. COVID-19 vs. non-COVID-19 related nosocomial pneumonias: any differences in etiology, prevalence, and mortality? Curr Opin Crit Care 2024; 30(5):463-69.
15. Aissaoui Y, Ennassimi Y, Myatt I, et al. What happened during COVID-19 in African ICUs? An observational study of pulmonary co-infections, superinfections, and mortality in Morocco. PlosOne 2022; 17(12):e0278175.
16. Rangelova V, Kevorkyan A, Raycheva R, et al. Ventilator-associated pneumonia in the neonatal intensive care unit—incidence and strategies for prevention. Diagnostics 2024; 14(3):240.
17. Boe D, Boule L, Kovacs E. Innate immune responses in the ageing lung. Clin Exp Immunol 2017; 187(1):16-25.
18. Whitsett, JA, Alenghat T. Respiratory epithelial cells orchestrate pulmonary innate immunity. Nat immunol 2015 16(1):27-35.
19. Khosla P, Jain K, Taneja V. Cytomegalovirus pneumonia in patients with severe COVID-19. J Assoc Physicians India 2024; 72(8):101-3.
20. Antonacci F, Petroncini M, Salvaterra E, et al. Lung Transplant Recipients and COVID-19: Report of Two Cases. J Clin Med 2023 12(13):4287.
21. Rouzé A, Nseir S. Hospital-acquired pneumonia/ventilator-associated pneumonia and ventilator-associated tracheobronchitis in COVID-19. in seminars in respiratory and critical care medicine. 2022. Thieme Medical Publishers, Inc.
22. Khan W, Safi A, Muneeb M, et al. Complications of invasive mechanical ventilation in critically Ill Covid-19 patients-A narrative review. Ann Med Surg 2022; 80.
23. Molloy EJ, et al, Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management. Ped Res 2023; 93(6):1499-508.
24. van Duijnhoven M, et al. A predominant cause of recurrence of ventilator-associated pneumonia in patients with COVID-19 are relapses. J Clin Med 2023; 12(18):5821.
25. Lee H, Kang M, Song WO, et al. Gender analysis in the development and validation of FFQ: a systematic review. Brit J Nut 2016; 115(4):666-671.
26. Kortchinsky T, Genty T, Gigandon A, et al. Including organ dysfunctions in a predictive score for nosocomial pneumonia after cardiothoracic surgery. Resp Care 2022; 67(12):1558-67.
27. Sarkkola C, Rounge TB, Simola-Ström S, et al. Validity of home-measured height, weight and waist circumference among adolescents. Eur J Pub Health 2016; 26(6):975-7.
28. Sinnathurai P, Buchbinder R, Hill C, et al. Comorbidity in psoriatic arthritis and rheumatoid arthritis. Int Med J 2018; 48(11):1360-8.
29. Pickens CO, Gao CA, Cuttica MJ, et al. Bacterial superinfection pneumonia in patients mechanically ventilated for COVID-19 pneumonia. Am J Resp Crit Care Med 2021; 204(8):921-32.
30. Assimakopoulos SF, et al. N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study. Infec Dis 2021; 53(11):847-854.
31. Lakman IA, Musin TI, Galiullina AR, et al. Risk factors of transfer to mechanical ventilation of COVID-19 patients in a retrospective non-randomized study. Vestn Ross Akad Med Nauk 2022; 77(1):33-42.
32. Solís-Huerta F, Martinez-Guerra BA, Roman-Montes CM, et al. Risk factors associated with the development of hospital-acquired infections in hospitalized patients with severe COVID-19. Antibiotics 2023; 12(7):1108.
33. Silva DHF, Camargos JHd, Rodrigues JG, et al. Impact of oral hygiene in patients undergoing mechanical ventilation in the COVID-19 pandemic. Rev Assoc Med Bras 2020; 66:96-101.
34. Pathak KV, et al. Molecular profiling of innate immune response mechanisms in ventilator-associated pneumonia. Mol Cell Proteomics 2020; 19(10):1688-705.
35. Felten M, et al. Overventilation-induced airspace acidification increases susceptibility to Pseudomonas pneumonia. bioRxiv 2024; 603041.
36. Gholami F, Hamidi Farahani R, Karimi Rahjerdi A, et al. Phase II randomized, double blind, placebo controlled, clinical trial of safety and immunogenicity of an inactivated SARS-CoV-2 vaccine FAKHRAVAC in adults aged 18–70 years. BMC Infect Dis 2023; 23:118.
37. Shoushtari M, Zeinoddini M, Fathi J, et al. One-step and Rapid Identification of SARS-CoV-2 using Real-Time Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP). Avicenna J Med Biotechnol 2024;16(1):3-8.
38. Sedighimehr N, Fathi J, Hadi N, et al. Rehabilitation, a necessity in hospitalized and discharged people infected with COVID-19: a narrative review. Physical Therapy Reviews 2021; 26(3):202-10.
39. Mahjoor M, Askari A, Khaledi M, et al. Relationship between blood groups and the risk of Covid-19 infection; a cohort study. J Med Bacteriol 2024; 12(2):26-33.
40. Khaledi M, Sameni F, Amini-Khoei H, et al. A comprehensive review of herbal recommendations with the potential to inhibit COVID-19 infection. J Med Bacteriol 2023; 11(5, 6):49-69.
| Files | ||
| Issue | Vol 13 No 2 (2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jmb.v13i2.18657 | |
| Keywords | ||
| COVID-19 Intensive care unit (ICU) Inflammation Mechanical ventilation Risk factors Ventilator-associated pneumonia (VAP). | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bozorgi M, Azadchehr MJ, Najafi S, Sedighimehr N, Fathi J, Pahlevani H, Najafizadeh M. Ventilator-Associated Pneumonia in COVID-19 Patients: Prevalence and Associated Factors. J Med Bacteriol. 2025;13(2):54-62.
