Causative Agents of Ventilator-Associated Pneumonia and Resistance to Antibiotics in COVID-19 Patients: A Systematic Review

Abstract

Patients with coronavirus disease 2019 (COVID-19) have an increased risk of ventilator-associated pneumonia (VAP). This systematic review updates information on the causative agents of VAP and resistance to antibiotics in COVID-19 patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, and LILACS databases from December 2019 to December 2021. Studies that described the frequency of causative pathogens associated with VAP and their antibiotic resistance patterns in critically ill COVID-19 adult patients were included. The Newcastle-Ottawa Quality Assessment Scale was used for critical appraisal. The data are presented according to the number or proportions reported in the studies. A total of 25 articles were included, involving 2766 VAP cases in COVID-19 patients (range 5–550 VAP cases). Most of the studies included were carried out in France (32%), Italy (20%), Spain (12%) and the United States (8%). Gram-negative bacteria were the most frequent causative pathogens of VAP (range of incidences in studies: P. aeruginosa 7.5–72.5%, K. pneumoniae 6.9–43.7%, E. cloacae 1.6–20% and A. baumannii 1.2–20%). S. aureus was the most frequent Gram-positive pathogen, with a range of incidence of 3.3–57.9%. The median incidence of Aspergillus spp. was 6.4%. Few studies have recorded susceptibility patterns among Gram-negative causative pathogens and have mainly reported extended-spectrum beta-lactamase (ESBL), AmpC, and carbapenem resistance. The median frequency of methicillin resistance among S. aureus isolates was 44.4%. Our study provides the first comprehensive description of the causative agents and antibiotic resistance in COVID-19 patients with VAP. Gram-negative bacteria were the most common pathogens causing VAP. Data on antibiotic resistance patterns in the published medical literature are limited, as well as information about VAP from low- and middle-income countries.

Multidrug-resistant VAP before and during the COVID-19 pandemic among hospitalized patients in a tertiary private hospital

“…The most frequently isolated microorganisms during the COVID-19 period in our cohort were Gram-negative organisms (K. pneumoniae and Acinetobacter baumannii). This is similar to other studies, 25,28 including in the local setting, where K. pneumoniae was commonly isolated among COVID-19 patients admitted in a tertiary-level government hospital. 26 However, in our cohort, there was an increase in ESBL-producing K. pneumoniae during the COVID-19 period compared to the pre-COVID-19 period.…”

The Human Superorganism: Using Microbes for Freedom vs. Fear

“…De Bruyn et al [51] also reported that a majority of COVID-19 patients had secondary bacterial infections during their hospital ICU stay. In a systematic review of ventilator-associated bacterial pneumonia among COVID-19 patients, Velásquez-Garcia et al [52] found that gram-negative bacteria were the most frequent causes of pneumonia with Staphylococcus aureus being the most common organism isolated among those patients.…”

Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital’s Adult Intensive Care Unit

“…These risk variables include advanced age, gender, prolonged MV, impaired consciousness, burns, the presence of comorbidities, previous antibiotic medication, invasive surgical procedures, and genetic polymorphisms [9]. Velásquez-Garcia et al (2022) proposed that the incidence, etiological agents, and patterns of antimicrobial resistance associated with VAP vary across surgical ICUs in Western countries and developing Asian nations [10]. The prevalence of resistant organisms in Thailand has seen a gradual upward trend over the last decade [11].…”