• Jean-François Llitjos, Swann Bredin, LascarrouJean-BaptisteJBIntensive Care Unit, Hôpital Hôtel-Dieu, Nantes, France., Thibaud Soumagne, Mariana Cojocaru, Maxime Leclerc, Arnaud Lepetit, Albin Gouhier, Julien Charpentier, Gaël Piton, Matthieu Faron, Annabelle Stoclin, and Frédéric Pène.
• 3i Department, Team Pulmonary and Systemic Immune Responses During Acute and Chronic Bacterial Infections, Institut Cochin, INSERM U1016, CNRS UMR8104, Université de Paris, Paris, France. jeanfrancois.llitjos@gustaveroussy.fr.
• Ann Intensive Care. 2021 Jan 29; 11 (1): 20.

BackgroundThe aim of this study is to determine whether severe COVID-19 patients harbour a higher risk of ICU-acquired pneumonia.MethodsThis retrospective multicentre cohort study comprised all consecutive patients admitted to seven ICUs for severe COVID-19 pneumonia during the first COVID-19 surge in France. Inclusion criteria were laboratory-confirmed SARS-CoV-2 infection and requirement for invasive mechanical ventilation for 48 h or more. Control groups were two historical cohorts of mechanically ventilated patients admitted to the ICU for bacterial or non-SARS-CoV-2 viral pneumonia. The outcome of interest was the development of ICU-acquired pneumonia. The determinants of ICU-acquired pneumonia were investigated in a multivariate competing risk analysis.ResultOne hundred and seventy-six patients with severe SARS-CoV-2 pneumonia admitted to the ICU between March 1st and 30th June of 2020 were included into the study. Historical control groups comprised 435 patients with bacterial pneumonia and 48 ones with viral pneumonia. ICU-acquired pneumonia occurred in 52% of COVID-19 patients, whereas in 26% and 23% of patients with bacterial or viral pneumonia, respectively (p < 0.001). Times from initiation of mechanical ventilation to ICU-acquired pneumonia were similar across the three groups. In multivariate analysis, the risk of ICU-acquired pneumonia remained independently associated with underlying COVID-19 (SHR = 2.18; 95 CI 1.2-3.98, p = 0.011).ConclusionCOVID-19 appears an independent risk factor of ICU-acquired pneumonia in mechanically ventilated patients with pneumonia. Whether this is driven by immunomodulatory properties by the SARS-CoV-2 or this is related to particular processes of care remains to be investigated.

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