The Significance of Ventilator-Associated Pneumonia in SARS-CoV-2 Patients: A Systematic Review

Abstract

Introduction: We performed a systematic review to compare the prevalence and mortality burden of ventilator-associated pneumonia (VAP) in SARS-CoV-2 patients. Material and methods: We conduct this systematic review and meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We searched PubMed, Scopus, Web of Science, Embase, and Cochrane from the database’s inception to February 10, 2021. Results: Five studies were identified. VAP occurred in 45.2% in the COVID-19 group compared to 26.0% for the non-COVID-19 group (OR = 3.17; 95% CI [1.94, 5.18]; p < 0.001; I2 = 67%). Three studies showed VAP recurrence to be 41.6% in the COVID-19 group and 20.2% in the non-COVID-19 group (OR = 3.12; 95% CI [1.87, 5.22]; p < 0.001; I2 = 0%). The mortality rate in COVID-19 vs. non-COVID-19 varies, amounting to 32.1% and 26.3%, respectively (OR = 1.33; 95% CI [1.07, 1.66]; p = 0.010; I2 = 49%). Conclusions: The findings from this case series reveal that the presence of ventilator-associated pneumonia in SARS-CoV-2 patients is a source of significant mortality. This study strengthens the importance of non-invasive mechanical ventilation strategies and also highlights the need for careful infection control surveillance in invasive mechanical ventilation. Due to the high rates of VAP and associated increased mortality, uprating antibiotic/antifungal therapy selection is also paramount in caring for SARS-CoV-2 cases admitted to the ICU.