Prevalence, Microorganism Pattern and Mortality Among Ventilator Associated Pneumonia With Critically-ill COVID-19 Patients in Persahabatan National Respiratory Referral Hospital in Indonesia: A Retrospective Single Center Study

Background: The prevalence (9-27%) and mortality (30-70%) of ventilator associated pneumonia (VAP) without COVID-19 was vary. Multicenter study in Europe showed prevalence VAP among COVID-19 was 58%, increased 2-3x in COVID-19 compared to pre-pandemic especially inintensive care unit. The mortality of COVID-19 in the ICU was 60,8% and increasing 50-70% in VAPgroup. VAP in intubated COVID-19 was associated with increased morbidity and mortality. Thisstudy evaluates the prevalence, microorganism pattern and mortality among VAP with COVID-19 in Indonesia. Methods: This retrospective study collected 757 medical record data of all hospitalized COVID-19 subjects in the Intensive Care Unit Persahabatan National Respiratory Referral Hospital from 2020-2022. This study included intubated COVID-19 for >48 hours and excluding subjects with age <18 years-old, pregnancy and probable COVID-19. The diagnosis of VAP was made according NHSN/CDC revised January 2023 algorithm consist of combination chest x-ray, clinical sign and endotracheal aspirate culture. The ethics committee of the Faculty Medicine, Universitas Indonesia had approved this study. Results: There were 196 eligible COVID-19 subjects. The median age was 57year-old (19-83), mostly males (60%). In accordance NHSN/CDC criteria, 60%(117 subjects) diagnosed as VAP. The endotracheal aspirate culture of VAP was Acine to bacterbaumannii (50,7%), Klebsiella pneumoniae (14,4%), Escherichia coli (11,5%). The microorganism pattern classified as 60,8% (42 subjects) multi-drug resistant, 18,9% extensive-drug resistant (13subjects) and 7,2% (9 subjects) pan-resistant organism. We analyzed the mortality of VAP among intubated COVID-19 subjects was as high as 98% with VAP and only 67% without VAP, OR 28,21(CI 95%, 6,45-123,24). Conclusion: The prevalence of VAP among COVID-19 subjects was highand increased mortality rates. The most frequent pathogen was Acinetobacter baumannii, Klebsiella pneumonia and Escherichia coli with multi-drug resistant pattern.