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For: Tetaj N, Capone A, Stazi GV, Marini MC, Garotto G, Busso D, Scarcia S, Caravella I, Macchione M, De Angelis G, Di Lorenzo R, Carucci A, Antonica MV, Gaviano I, Inversi C, Agostini E, Canichella F, Taloni G, Evangelista F, Onnis I, Mogavero G, Lamanna ME, Rubino D, Di Frischia M, Porcelli C, Cesi E, Antinori A, Palmieri F, D’Offizi G, Taglietti F, Nisii C, Cataldo MA, Ianniello S, Campioni P, Vaia F, Nicastri E, Girardi E, Marchioni L, Grisaro A, Farina A, Merino RJC, Micarelli S, Petroselli V, Ragosta G, Zito S. Epidemiology of ventilator-associated pneumonia in ICU COVID-19 patients: an alarming high rate of multidrug-resistant bacteria. J Anesth Analg Crit Care 2022. [PMCID: PMC9389502 DOI: 10.1186/s44158-022-00065-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]

For:	Tetaj N, Capone A, Stazi GV, Marini MC, Garotto G, Busso D, Scarcia S, Caravella I, Macchione M, De Angelis G, Di Lorenzo R, Carucci A, Antonica MV, Gaviano I, Inversi C, Agostini E, Canichella F, Taloni G, Evangelista F, Onnis I, Mogavero G, Lamanna ME, Rubino D, Di Frischia M, Porcelli C, Cesi E, Antinori A, Palmieri F, D’Offizi G, Taglietti F, Nisii C, Cataldo MA, Ianniello S, Campioni P, Vaia F, Nicastri E, Girardi E, Marchioni L, Grisaro A, Farina A, Merino RJC, Micarelli S, Petroselli V, Ragosta G, Zito S. Epidemiology of ventilator-associated pneumonia in ICU COVID-19 patients: an alarming high rate of multidrug-resistant bacteria. J Anesth Analg Crit Care 2022. [PMCID: PMC9389502 DOI: 10.1186/s44158-022-00065-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]

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Cited by Other Article(s)

Montrucchio G, Balzani E, Sales G, Vaninetti A, Grillo F, Trompeo AC, Zanierato M, Fanelli V, Corcione S, De Rosa FG, Curtoni A, Costa C, Brazzi L. Multidrug-resistant pathogens and ventilator-associated pneumonia in critically ill COVID-19 and non-COVID-19 patients: a prospective observational monocentric comparative study. Respir Res 2024;25:168. [PMID: 38637766 PMCID: PMC11027225 DOI: 10.1186/s12931-024-02779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open

Abstract

BACKGROUND

The COVID-19 pandemic has increased the incidence of ventilator-associated pneumonia (VAP) among critically ill patients. However, a comparison of VAP incidence in COVID-19 and non-COVID-19 cohorts, particularly in a context with a high prevalence of multidrug-resistant (MDR) organisms, is lacking.

MATERIAL AND METHODS

We conducted a single-center, mixed prospective and retrospective cohort study comparing COVID-19 patients admitted to the intensive care unit (ICU) of the "Città della Salute e della Scienza" University Hospital in Turin, Italy, between March 2020 and December 2021 (COVID-19 group), with a historical cohort of ICU patients admitted between June 2016 and March 2018 (NON-COVID-19 group). The primary objective was to define the incidence of VAP in both cohorts. Secondary objectives were to evaluate the microbial cause, resistance patters, risk factors and impact on 28 days, ICU and in-hospital mortality, duration of ICU stay, and duration of hospitalization).

RESULTS

We found a significantly higher incidence of VAP (51.9% - n = 125) among the 241 COVID-19 patients compared to that observed (31.2% - n = 78) among the 252 NON-COVID-19 patients. The median SOFA score was significantly lower in the COVID-19 group (9, Interquartile range, IQR: 7-11 vs. 10, IQR: 8-13, p < 0.001). The COVID-19 group had a higher prevalence of Gram-positive bacteria-related VAP (30% vs. 9%, p < 0.001), but no significant difference was observed in the prevalence of difficult-to-treat (DTR) or MDR bacteria. ICU and in-hospital mortality in the COVID-19 and NON-COVID-19 groups were 71% and 74%, vs. 33% and 43%, respectively. The presence of COVID-19 was significantly associated with an increased risk of 28-day all-cause hospital mortality (Hazard ratio, HR: 7.95, 95% Confidence Intervals, 95% CI: 3.10-20.36, p < 0.001). Tracheostomy and a shorter duration of mechanical ventilation were protective against 28-day mortality, while dialysis and a high SOFA score were associated with a higher risk of 28-day mortality.

CONCLUSION

COVID-19 patients with VAP appear to have a significantly higher ICU and in-hospital mortality risk regardless of the presence of MDR and DTR pathogens. Tracheostomy and a shorter duration of mechanical ventilation appear to be associated with better outcomes.

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Affiliation(s)

Giorgia Montrucchio Department of Surgical Sciences, University of Turin, Turin, Italy. Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy.
Eleonora Balzani Department of Surgical Sciences, University of Turin, Turin, Italy
Gabriele Sales Department of Surgical Sciences, University of Turin, Turin, Italy Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
Anna Vaninetti Department of Surgical Sciences, University of Turin, Turin, Italy
Francesca Grillo Department of Surgical Sciences, University of Turin, Turin, Italy
Anna Chiara Trompeo Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
Marinella Zanierato Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
Vito Fanelli Department of Surgical Sciences, University of Turin, Turin, Italy Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
Silvia Corcione Department of Medical Sciences, University of Turin, Turin, Italy Tufts University School of Medicine, Boston, MA, 02111, USA
Francesco Giuseppe De Rosa Department of Medical Sciences, University of Turin, Turin, Italy
Antonio Curtoni Department of Public Health and Paediatrics, University of Turin, Turin, Italy Microbiology and Virology Laboratory, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, Turin, 10126, Italy
Cristina Costa Department of Public Health and Paediatrics, University of Turin, Turin, Italy Microbiology and Virology Laboratory, Città Della Salute e Della Scienza Hospital, Corso Dogliotti 14, Turin, 10126, Italy
Luca Brazzi Department of Surgical Sciences, University of Turin, Turin, Italy Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy

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Rodríguez A, Gómez F, Sarvisé C, Gutiérrez C, Giralt MG, Guerrero-Torres MD, Pardo-Granell S, Picó-Plana E, Benavent-Bofill C, Trefler S, Berrueta J, Canadell L, Claverias L, Esteve Pitarch E, Olona M, García Pardo G, Teixidó X, Bordonado L, Sans MT, Bodí M. Clinical and Microbiological Impact of Implementing a Decision Support Algorithm through Microbiologic Rapid Diagnosis in Critically Ill Patients: An Epidemiological Retrospective Pre-/Post-Intervention Study. Biomedicines 2023;11:3330. [PMID: 38137551 PMCID: PMC10741655 DOI: 10.3390/biomedicines11123330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open

Affiliation(s)

Alejandro Rodríguez Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain; Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain
Frederic Gómez Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain Centre for Biomedical Research in Infectious Diseases Network (CIBERINFEC), 28220 Madrid, Spain
Carolina Sarvisé Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Cristina Gutiérrez Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Montserrat Galofre Giralt Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
María Dolores Guerrero-Torres Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Sergio Pardo-Granell Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Ester Picó-Plana Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Clara Benavent-Bofill Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Sandra Trefler Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
Julen Berrueta Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Tarragona Health Data Research Working Group (THeDaR), Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Laura Canadell Faculty of Medicine, Department of Basic Medical Sciences, Rovira & Virgili University, 43005 Tarragona, Spain; Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Laura Claverias Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.)
Erika Esteve Pitarch Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Hospital Pharmacy, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Montserrat Olona Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Graciano García Pardo Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Preventive Medicine, Infection Control Group, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
Xavier Teixidó ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
Laura Bordonado ICU Nursing, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain; (X.T.); (L.B.)
María Teresa Sans Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Microbiology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain Molecular Biology/Clinical Analysis Laboratory, Hospital Universitari de Tarragona Joan XXIII, 43005 Tarragona, Spain
María Bodí Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, Mallafre Guasch 4, 43005 Tarragona, Spain; (S.T.); (J.B.); (L.C.); (M.B.) Pere Virgili Health Research Institute (IISPV), 43005 Tarragona, Spain; (F.G.); (C.S.); (C.G.); (M.G.G.); (M.D.G.-T.); (S.P.-G.); (E.P.-P.); (C.B.-B.); (E.E.P.); (M.O.); (G.G.P.); (M.T.S.) Centre for Biomedical Research in Respiratory Diseases Network (CIBERES), 43005 Tarragona, Spain Faculty of Medicine, Department of Medicine and Surgery, Rovira & Virgili University, 43005 Tarragona, Spain

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Mangioni D, Panigada M, Palomba E, Bobbio C, Chatenoud L, Alagna L, Fumagalli J, Gori A, Grancini A, Guzzardella A, Lombardi A, Matinato C, Meli A, Muscatello A, Porretti L, Tomasello M, Trombetta E, Valenti L, Bandera A, Grasselli G. Incidence, microbiological and immunological characteristics of ventilator-associated pneumonia assessed by bronchoalveolar lavage and endotracheal aspirate in a prospective cohort of COVID-19 patients: CoV-AP study. Crit Care 2023;27:369. [PMID: 37749631 PMCID: PMC10521470 DOI: 10.1186/s13054-023-04658-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open

Abstract

BACKGROUND

No univocal recommendation exists for microbiological diagnosis of ventilator-associated pneumonia (VAP). Sampling of either proximal or distal respiratory tract likely impacts on the broad range of VAP incidence between cohorts. Immune biomarkers to rule-in/rule-out VAP diagnosis, although promising, have not yet been validated. COVID-19-induced ARDS made VAP recognition even more challenging, often leading to overdiagnosis and overtreatment. We evaluated the impact of different respiratory samples and laboratory techniques on VAP incidence and microbiological findings in COVID-19 patients.

METHODS

Prospective single-centre cohort study conducted among COVID-19 mechanically ventilated patients in Policlinico Hospital (Milan, Italy) from January 2021 to May 2022. Microbiological confirmation of suspected VAP (sVAP) was based on concomitant endotracheal aspirates (ETA) and bronchoalveolar lavage (BAL). Conventional and fast microbiology (FILMARRAY® Pneumonia Panel plus, BALFAPPP) as well as immunological markers (immune cells and inflammatory cytokines) was analysed.

RESULTS

Seventy-nine patients were included. Exposure to antibiotics and steroid therapy before ICU admission occurred in 51/79 (64.6%) and 60/79 (65.9%) patients, respectively. Median duration of MV at VAP suspicion was 6 (5-9) days. Incidence rate of microbiologically confirmed VAP was 33.1 (95% CI 22.1-44.0) and 20.1 (95% CI 12.5-27.7) according to ETA and BAL, respectively. Concordance between ETA and BAL was observed in 35/49 (71.4%) cases, concordance between BALFAPPP and BAL in 39/49 (79.6%) cases. With BAL as reference standard, ETA showed 88.9% (95% CI 70.8-97.7) sensitivity and 50.0% (95% CI 28.2-71.8) specificity (Cohen's Kappa 0.40, 95% CI 0.16-0.65). BALFAPPP showed 95.0% (95% CI 75.1-99.9) sensitivity and 69% (95% CI 49.2-84.7) specificity (Cohen's Kappa 0.60, 95% CI 0.39-0.81). BAL IL-1β differed significantly between VAP (135 (IQR 11-450) pg/ml) and no-VAP (10 (IQR 2.9-105) pg/ml) patients (P = 0.03).

CONCLUSIONS

In COVID-19 ICU patients, differences in microbial sampling at VAP suspicion could lead to high variability in VAP incidence and microbiological findings. Concordance between ETA and BAL was mainly limited by over 20% of ETA positive and BAL negative samples, while BALFAPPP showed high sensitivity but limited specificity when evaluating in-panel targets only. These factors should be considered when comparing results of cohorts with different sampling. BAL IL-1β showed potential in discriminating microbiologically confirmed VAP.

CLINICAL TRIAL REGISTRATION

NCT04766983, registered on February 23, 2021.

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Affiliation(s)

Davide Mangioni Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
Mauro Panigada Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Emanuele Palomba Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy.
Chiara Bobbio Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Liliane Chatenoud Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
Laura Alagna Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Jacopo Fumagalli Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Andrea Gori Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
Anna Grancini Microbiology Laboratory, Clinical Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Amedeo Guzzardella Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Andrea Lombardi Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
Caterina Matinato Microbiology Laboratory, Clinical Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Andrea Meli Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Antonio Muscatello Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Laura Porretti Flow Cytometry and Cell Sorting Laboratory, Clinical Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Mara Tomasello Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
Elena Trombetta Flow Cytometry and Cell Sorting Laboratory, Clinical Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Luca Valenti Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy Precision Medicine, Biological Resource Center Unit, Department of Transfusion Medicine, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Alessandra Bandera Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
Giacomo Grasselli Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy Department of Anaesthesia, Critical Care and Emergency, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

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Dibos M, Haschka SJ, Abbassi R, Schneider J, Schmid RM, Rasch S, Lahmer T. Influence of a Structured Microbiological Endotracheal Monitoring Program on the Outcome of Critically Ill COVID-19 Patients: An Observational Study. J Clin Med 2023;12:5622. [PMID: 37685689 PMCID: PMC10488947 DOI: 10.3390/jcm12175622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open

Gatti A, Fassini P, Mazzone A, Rusconi S, Brando B, Mistraletti G. Kinetics of CD169, HLA-DR, and CD64 expression as predictive biomarkers of SARS-CoV2 outcome. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023;3:6. [PMID: 37386613 PMCID: PMC10041484 DOI: 10.1186/s44158-023-00090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/28/2023] [Indexed: 03/29/2023]

Abstract

INTRODUCTION

Discriminating between virus-induced fever from superimposed bacterial infections is a common challenge in intensive care units. Superimposed bacterial infections can be detected in severe SARS-CoV2-infected patients, suggesting the important role of the bacteria in COVID-19 evolution. However, indicators of patients' immune status may be of help in the management of critically ill subjects. Monocyte CD169 is a type I interferon-inducible receptor that is up-regulated during viral infections, including COVID-19. Monocyte HLA-DR expression is an immunologic status marker, that decreases during immune exhaustion. This condition is an unfavorable prognostic biomarker in septic patients. Neutrophil CD64 upregulation is an established indicator of sepsis.

METHODS

In this study, we evaluated by flow cytometry the expression of cellular markers monocyte CD169, neutrophil CD64, and monocyte HLA-DR in 36 hospitalized patients with severe COVID-19, as possible indicators of ongoing progression of disease and of patients' immune status. Blood testings started at ICU admission and were carried on throughout the ICU stay and extended in case of transfer to other units, when applicable. The marker expression in mean fluorescence intensity (MFI) and their kinetics with time were correlated to the clinical outcome.

RESULTS

Patients with short hospital stay (≤15 days) and good outcome showed higher values of monocyte HLA-DR (median 17,478 MFI) than long hospital stay patients (>15 days, median 9590 MFI, p= 0.04) and than patients who died (median 5437 MFI, p= 0.05). In most cases, the recovery of the SARS-CoV2 infection-related signs was associated with the downregulation of monocyte CD169 within 17 days from disease onset. However in three surviving long hospital stay patients, a persistent upregulation of monocyte CD169 was observed. An increased neutrophil CD64 expression was found in two cases with a superimposed bacterial sepsis.

CONCLUSION

Monocyte CD169, neutrophil CD64, and monocyte HLA-DR expression can be used as predictive biomarkers of SARS-CoV2 outcome in acutely infected patients. The combined analysis of these indicators can offer a real-time evaluation of patients' immune status and of viral disease progression versus superimposed bacterial infections. This approach allows to better define the patients' clinical status and outcome and may be useful to guide clinicians' decisions. Our study focused on the discrimination between the activity of viral and bacterial infections and on the detection of the development of anergic states that may correlate with an unfavorable prognosis.

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