Effects of the Selective Decontamination of the Digestive Tract (SDD) on Pulmonary Secondary Infections in Patients with COVID-19 Acute Respiratory Distress Syndrome: A Retrospective Single Centre Experience

Abstract

Definitive data on the incidence rate of ventilator-associated pneumonia (VAP) in COVID-19 are still lacking, ranging from 29 to 58%. To date, most of the existing literature refers to patients who are not subjected to VAP prevention with selective decontamination of the digestive tract (SDD). We retrospectively collected data on all COVID-19 patients admitted to our ICU during the second phase of the pandemic with the aim of assessing the occurrence of VAP and the related mortality at 30 days and comparing our findings with the available literature. Of 213 patients, only 74 were eligible for the analysis. An incidence of 6.90 VAP per 1000 days of mechanical ventilation was detected. Apart from a smoking habit (0% vs. 10%, p p = 0.026), patients who developed VAP did not differ significantly from those who did not regarding comorbidities, steroid use, and the severity of COVID-19. VAP were predominantly caused by mono-microbial Gram-negative or fungal infections. Mortality was significantly higher in those who developed VAP (86 vs. 33%, p = 0.002). Our evidence aligned with the available literature in assuming a possible role of SDD in reducing the incidence of VAP in COVID-19 patients, with a possible impact on related mortality and costs.

Keywords

• selective decontamination of the digestive tract
• ventilator-associated pneumonia
• pulmonary infections
• COVID-19
• acute respiratory distress syndrome
• mechanical ventilation