Background Hospitalized patients with COVID-19 admitted to the intensive care unit (ICU) and requiring mechanical ventilation are at risk of ventilator-associated bacterial infections secondary to SARS-CoV-2 infection. Our study aimed to investigate clinical features of Staphylococcus aureus ventilator-associated pneumonia (SA-VAP) and, if bronchoalveolar lavage samples were available, lung bacterial community features in ICU patients with or without COVID-19. Methods We prospectively included hospitalized patients with COVID-19 across two medical ICUs of the Fondazione Policlinico Universitario A. Gemelli IRCCS (Rome, Italy), who developed SA-VAP between 20 March 2020 and 30 October 2020 (thereafter referred to as cases). After 1:2 matching based on the simplified acute physiology score II (SAPS II) and the sequential organ failure assessment (SOFA) score, cases were compared with SA-VAP patients without COVID-19 (controls). Clinical, microbiological, and lung microbiota data were analyzed. Results We studied two groups of patients (40 COVID-19 and 80 non-COVID-19). COVID-19 patients had a higher rate of late-onset (87.5% versus 63.8%; p = 0.01), methicillin-resistant (65.0% vs 27.5%; p < 0.01) or bacteremic (47.5% vs 6.3%; p < 0.01) infections compared with non-COVID-19 patients. No statistically significant differences between the patient groups were observed in ICU mortality ( p = 0.12), clinical cure ( p = 0.20) and microbiological eradication ( p = 0.31). On multivariable logistic regression analysis, SAPS II and initial inappropriate antimicrobial therapy were independently associated with ICU mortality. Then, lung microbiota characterization in 10 COVID-19 and 16 non-COVID-19 patients revealed that the overall microbial community composition was significantly different between the patient groups (unweighted UniFrac distance, R 2 0.15349; p < 0.01). Species diversity was lower in COVID-19 than in non COVID-19 patients (94.4 ± 44.9 vs 152.5 ± 41.8; p < 0.01). Interestingly, we found that S. aureus (log 2 fold change, 29.5), Streptococcus anginosus subspecies anginosus (log 2 fold change, 24.9), and Olsenella (log 2 fold change, 25.7) were significantly enriched in the COVID-19 group compared to the non–COVID-19 group of SA-VAP patients. Conclusions In our study population, COVID-19 seemed to significantly affect microbiological and clinical features of SA-VAP as well as to be associated with a peculiar lung microbiota composition. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03623-4.
【저자키워드】 COVID-19, Bronchoalveolar lavage, Staphylococcus aureus, Ventilator-associated pneumonia, Lung microbiota, 【초록키워드】 Mortality, intensive care, mechanical ventilation, SARS-COV-2 infection, Infection, lung, risk, Italy, ICU, microbiota, clinical, Patient, Community, Bacterial infection, Antimicrobial therapy, SOFA, group, microbial community, patients, clinical feature, Bacterial, Analysis, Staphylococcus aureus, COVID-19 patient, Organ failure, Non-COVID-19, Non-COVID-19 patients, Fold change, supplementary material, study population, multivariable logistic regression, statistically significant difference, COVID-19 group, Rome, IRCCS, Affect, controls, feature, ICU patient, medical icu, initial, log, Result, analyzed, significantly, the patient, Specy, bronchoalveolar lavage sample, hospitalized patient, two group, R 2, non COVID-19 patient, non-COVID-19 patient, patients with COVID-19, patients without COVID-19, Streptococcus anginosus, with COVID-19, 【제목키워드】 lung, Patient, clinical feature, Staphylococcus aureus,