Lung abscess following ventilator-associated pneumonia during COVID-19: a retrospective multicenter cohort study

BACKGROUND

Patients undergoing mechanical ventilation (MV) for COVID-19 exhibit an increased risk of ventilator-associated pneumonia (VAP). The occurrence of lung abscesses following VAP in these patients has been poorly studied. We aimed to describe the incidence, characteristics, risk factors and prognosis of lung abscesses complicating VAP after COVID-19.

METHODS

We conducted an observational, retrospective study in three French intensive care units. Patients admitted for acute respiratory failure with a confirmed SARS-CoV-2 PCR and requiring MV for more than 48 h were included.

RESULTS

Among the 507 patients included, 326 (64%) had a documented VAP. Of these, 23 (7%) developed a lung abscess. Enterobacterales (15/23, 65%) were the main documentation, followed by non-fermenting Gram-negative bacilli (10/23, 43%) and Gram-positive cocci (8/23, 35%). Lung abscesses were mainly plurimicrobial (15/23, 65%). In multivariate analysis, a plurimicrobial 1st VAP episode (OR (95% CI) 2.93 (1.16-7.51); p = 0.02) and the use of hydrocortisone (OR (95% CI) 4.86 (1.95-12.1); p = 0.001) were associated with lung abscess development. Intensive care unit (ICU) mortality of patients with lung abscesses reached 52%, but was not significantly higher than for patients with VAP but no lung abscess. Patients with lung abscesses had reduced ventilator-free days at day 60, a longer duration of MV and ICU stay than patients with VAP but no lung abscess (respectively, 0 (0-3) vs. 16 (0-42) days; p < 0.001, 49 (32-73) vs. 25 (11-41) days; p < 0.001, 52 (36-77) vs. 28 (16-47) days; p < 0.001).

CONCLUSIONS

Lung abscessing pneumonia is not uncommon among COVID-19 patients developing VAP. A plurimicrobial first VAP episode and the use of hydrocortisone are independently associated with this complication. In COVID-19 patients with persistent VAP, a chest CT scan investigating the evolution toward lung abscess should be considered.

First Report of Macrophomina phaseolina Causing a Crown Rot of Strawberry in Florida

Strawberry (Fragaria × ananassa Duchesne) is produced as an annual winter crop in raised, plastic-mulched beds on 2,800 ha in west central Florida. In December 2001, a grower submitted collapsed and dying strawberry plants from a commercial field to the University of Florida in Dover. The cut crowns of affected plants revealed dark brown necrotic areas on the margins and along the woody vascular ring. Macrophomina phaseolina was isolated from pieces of infected tissue cut aseptically from the crowns and placed on a medium containing 12 g of Difco potato dextrose broth, 17 g of Bacto agar, 250 mg of ampicillin, and 100 mg of streptomycin sulfate per liter of water. The fungus produced numerous, dark, oblong sclerotia in the isolation medium after 4 to 5 days incubation at 24°C under constant fluorescent lighting. In 10-day-old cultures, sclerotia ranged in size from 55 to 190 μm long by 50 to 135 μm wide (average 105 × 74 μm). Ostiolate pycnidia bearing relatively large, broadly ellipsoidal, hyaline conidia occasionally developed on the host tissue after 8 to 10 days of incubation (2). During the 2003-2004 season, M. phaseolina was isolated from dying strawberry plants taken from the original field and two additional farms. Affected plants were often found along field margins or other areas inadequately fumigated with methyl bromide. Two single-spore isolates from different fields were tested for pathogenicity on nursery runner plants (cv. Strawberry Festival) grown for 4 weeks in the greenhouse on artificial potting soil. The fungal isolates were grown on corn meal agar at 24°C for 4 days and allowed to colonize sterile wooden toothpicks placed on the medium for an additional 5 days. Prior to use, the toothpicks were sterilized by autoclaving twice in deionized water and a third time in V8 juice. Six plants were inoculated with each isolate by inserting a colonized toothpick into each crown. Sterile, V8-infused toothpicks were inserted into the crowns of corresponding control plants. The plants were incubated in a greenhouse in a randomized complete block design with two replicates of three plants each. After 3 days, 33 to 100% of the inoculated plants developed wilting in one or more leaves. All inoculated plants collapsed or died within 2 weeks of inoculation, while the control plants remained healthy during the observation period. The pathogen was readily reisolated from inoculated plants. Charcoal rot disease caused by M. phaseolina has been reported on strawberry in France, India, and Illinois (2,3). To our knowledge, this is the first report from Florida. M. phaseolina may be an emerging threat as the Florida strawberry industry transitions from methyl bromide to other fumigants in 2005. References: (1) J. Maas. Macrophomina leaf blight and dry crown rot. Page 26 in: Compendium of Strawberry Diseases. 2nd ed. J. L. Maas, ed. The American Phytopathological Society, St. Paul, MN, 1998. (2) G. S. Smith and T. D. Wyllie. Charcoal rot. Pages 29-31 in: Compendium of Soybean Diseases. G. L. Hartman et al., eds. 4th ed. The American Phytopathological Society, St. Paul, MN. 1999. (3) B. Tweedy et al. Plant Dis. Rep. 42:107, 1958.