French national epidemiology of bacterial superinfections in ventilator-associated pneumonia in patients infected with COVID-19: the COVAP study
Authors: Pichon Maxime , Cremniter Julie , Burucoa Christophe ,   the COVAP Study group, Abdallah Sahar , Alauzet Corentine , Alix Tom , Allouche Kahina , Amara Marlène , Anglade Florence , Anguel Nadia , Armand-Lefevre Laurence , Barbier Francois , Beauruelle Clémence , Bemer Pascale , Benmansour Hanaa , Bercot Béatrice , Bergon Ludovic , Bertei Dominique , Berthon Marc , Beuret Pascal , Bientz Léa , Billon Laura , Bousquet Aurore , Brousse Amélie , Broutin Lauranne , Bruneel Fabrice , Cady Anne , Camelena Francois , Carrer-Causeret Amélie , Caspar Yvan , Chemali Lotfi , Jaouen Anne Christine , Cocherie Théophile , Cointe Aurélie , Corvec Stephane , Courtellemont Laura , Cuzon Gaelle , Dao Anne , Delbove Agathe , D’Humieres Camille , Djamdjian Laura , Doloy Alexandra , Dorin Joséphine , Dumont Yann , Dumoulard Bruno , Sayed Faten El , Fangous Marie-Sarah , Favier Laurent , Ferre Alexis , Fortineau Nicolas , Francois Juliette , Gachet Clémence , Gargouri Mahmoud , Garot Denis , Gastli Nabil , Gauvin Elena , Geneau Isabelle , Geslain Guillaume , Goury Antoine , Grenot Romaric , Grillon Antoine , Guillard Thomas , Guillouzouic Aurélie , Guinard Jerome , Guiraud Jennifer , Gyde Esther , Henry Christophe , Jeannot Katy , Kempf Marie , Kouatchet Achille , Landraud Luce , Lanotte Philippe , Larreche Sebastien , Le Gallou Brice , Le Breton Elodie , Leblanc Pierre-Etienne , Lecuyer Hervé , Lemee Ludovic , Lessard Pauline , Leyssene David , Lureau Pierre , Manteaux Anne-Elisabeth , Mervent Michael , Micaelo Maite , Michaud Anthony , Moquet Olivier , Muggeo Anaelle , Ochin Evelina , Ochocki Patrick , Ouchikhe Abdelali , Paluch Maxime , Pancher-Lory Marie , Pantel Alix , Pastuszka Adeline , Perruche Ophélie , Peuchant Olivia , Piau Caroline , Plouzeau-Jayle Chloé , Quesnel Kevin , Richard Lucie , Riverain Emeline , Robert Alexandre , Roux Anne-Laure , Saint-Sardos Pierre , Serpin Laurent , Silva Daniel , Sivadon-Tardy Valerie , Toumert Karim , Tournus Céline , Touroult-Jupin Pauline , Tran Quy Antoine , Vachee Anne , Vanjak Christian , Vernet-Garnier Véronique , Vinclair Camille , Violette Jérémie , Walewski Violaine 
Published: June 2023

Abstract
Background
Description and comparison of bacterial characteristics of ventilator-associated pneumonia (VAP) between critically ill intensive care unit (ICU) patients with COVID-19-positive, COVID + ; and non-COVID-19, COVID-.

Methods
Retrospective, observational, multicenter study that focused on French patients during the first wave of the pandemic (March–April 2020).

Results
935 patients with identification of at least one bacteriologically proven VAP were included (including 802 COVID +). Among Gram-positive bacteria, S. aureus accounted for more than two-thirds of the bacteria involved, followed by Streptococcaceae and enterococci without difference between clinical groups regarding antibiotic resistance. Among Gram-negative bacteria, Klebsiella spp. was the most frequently observed bacterial genus in both groups, with K. oxytoca overrepresented in the COVID- group (14.3% vs. 5.3%; p < 0.05). Cotrimoxazole-resistant bacteria were over-observed in the COVID + group (18.5% vs. 6.1%; p <0.05), and after stratification for K. pneumoniae (39.6% vs. 0%; p <0.05). In contrast, overrepresentation of aminoglycoside-resistant strains was observed in the COVID- group (20% vs. 13.9%; p < 0.01). Pseudomonas sp. was more frequently isolated from COVID + VAPs (23.9% vs. 16.7%; p <0.01) but in COVID- showed more carbapenem resistance (11.1% vs. 0.8%; p <0.05) and greater resistance to at least two aminoglycosides (11.8% vs. 1.4%; p < 0.05) and to quinolones (53.6% vs. 7.0%; p <0.05). These patients were more frequently infected with multidrug-resistant bacteria than COVID + (40.1% vs. 13.8%; p < 0.01).

Conclusions
The present study demonstrated that the bacterial epidemiology and antibiotic resistance of VAP in COVID + is different from that of COVID- patients. These features call for further study to tailor antibiotic therapies in VAP patients.