Early bacterial co-infection in ARDS related to COVID-19
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LETTER
Early bacterial co‑infection in ARDS related to COVID‑19 Louis Kreitmann1, Céline Monard2, Olivier Dauwalder3, Marie Simon1 and Laurent Argaud1* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, Originating in China in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic reached Europe in March 2020. In its most severe expression, coronavirus disease 2019 (COVID-19) pneumonia presents as the acute respiratory distress syndrome (ARDS), mandating intensive care unit (ICU) admission and invasive mechanical ventilation (IMV) [1]. Bacterial coinfections, well documented in other respiratory viral infections, notably influenza [2], have not yet been investigated at the onset of COVID-19 pneumonia. To address this, we conducted a prospective cohort study in three ICUs of Lyon University-Affiliated Hospital. This study was approved by the institutional ethics committee (Comité d’Ethique du CHU de Lyon, N°20-42). Consecutive patients with PCR-confirmed SARS-CoV-2 infection requiring IMV for ARDS (Berlin definition) were recruited from March 16th to April 6th 2020, and were followed-up for 28 days. Endotracheal aspirates (ETA) or bronchoalveolar lavages (BAL) were sampled in the 24 h following tracheal intubation, and microbiology analyses were performed, including conventional culture and a multiplex PCR assay (BioFire® FilmArray® Pneumonia Panel; bioMérieux, Marcy-l’Etoile, France) [3]. Early bacterial coinfection was defined as the identification of at least 1 bacterial species by conventional culture and/or PCR, with a threshold of ≥ 105 colony forming units or genome copies per milliliter in ETA, and ≥ 104 in BAL, respectively. From 56 eligible patients, the 47 consecutive patients with respiratory secretions sampled in the 24 h following *Correspondence: laurent.argaud@chu‑lyon.fr 1 Médecine Intensive‑Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d’Arsonval, 69437 Lyon Cedex 03, France Full author information is available at the end of the article
tracheal intubation were predominantly male (sex ratio: 3.3), most were younger than 70 years of age (n = 32, 68.1%), with a high prevalence of obesity (body mass index ≥ 30 kg.m−2, n = 23, 48.9%). Using ETA (n = 45) and BAL (n = 2), early bacterial coinfection was documented in 13 patients [27.7%, by PCR (n = 12) and conventional culture (n = 1)]; the median interval between intubation and tracheal sampling was 3 h [IQR (1–9)]. Among the 39 patients with both standard culture and PCR, 29 (74.4%) had both negative culture and negative PCR and 10 (25.6%) both positive culture and positive PCR. There was no significant difference in either characteristics and outcomes according to the presence of coinfection (Table 1). Three bacterial species accounted for ≥ 90% of all identified bacteria: Staphylococcus aureus (all methicillin-sensitive), Haemophilus influenzae, and Streptococcus pneumoniae. Coinfection with multiple bacterial species was documented in 5 patients (10.6%). All coin
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