Patients on mechanical ventilation (MV) following SARS-CoV-2 pneumonia frequently developventilator-associated pneumonia (VAP). The incidence of MVAP during SARS-CoV-2 infectionsranges from 50 to nearly 90%. In addition, up to 80% of recurrences of VAP (a newepisode, most often attributable to the same bacteria) have been described, reflectingthe failure of the initial antibiotic therapy. This incidence is much higher than thatdescribed for other etiologies of acute respiratory distress syndrome (ARDS). Theinvestigators hypothesize that during VAP, there is an alteration of the diffusion ofintravenous antibiotics in the lung parenchyma in COVID-19 patients in relation toseveral factors characteristic of SARS-CoV-2 infection. This altered diffusion mayexplain the high number of recurrences of MVAP compared to non-COVID-19 patients.
Not Provided
Other: blood sample and bronchoalveolar lavage
These patients are put on VM as part of their care and present a suspicion of a 1st
episode of PAVM for which a microbiological sample is taken and a probabilistic
antibiotic therapy is started with the PIP-TAZ association (D0). A plasma PIP-TAZ assay
will be performed 48 hours after the start of antibiotic therapy with PIP-TAZ. Blood urea
will be measured and a mini-LBA (performed with a Combicatheter®) will be performed to
measure PIP-TAZ and urea in the ELF.
On day 7 of the antibiotic therapy (last day of the planned antibiotic therapy), the same
samples are taken and the same analyses are performed + bacteriology on the mini BAL. For
patients for whom antibiotic therapy has been interrupted because of sterile samples, the
samples taken at D7 will not be taken.
The clinical outcome of the patient will then be recorded until D60.
Inclusion Criteria:
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1. Patient over 18 years of age 2. Patient has given consent or consent obtained
from the trusted person if the patient is not capable of consenting, after
informed consent.
3. Patient with ARDS 4. Patient requiring MV for ARDS (as defined by Berlin (15)),
regardless of etiology (COVID-19 or other cause of ARDS) 5. Patient with
suspected 1st episode of ARDS for which microbiological sampling is performed
(bronchial aspiration, protected distal sampling (PDS), bronchoalveolar lavage
(BAL)) 6. Patients who have received probabilistic antibiotic therapy within 24
hours of the microbiological sample, including piperacillin-tazobactam
(PIP-TAZ) administered according to current recommendations.
7. Patient who is a beneficiary of or affiliated to a social security system
Exclusion Criteria:
1. Patients for whom PIP-TAZ is administered as a discontinuous infusion.
2. Contraindication to the realization of a mini-LBA: patient whose respiratory state
is too precarious for the realization of a mini-LBA for intra pulmonary antibiotics
dosage (SpO2<94% under FiO2 100% under VM), presence of a non drained pneumothorax,
bronchial prosthesis, recent bronchial suture
3. Patient with a second episode of PAVM.
4. Patients with KDIGO stage ≥ 3 renal failure or extra-renal replacement therapy
(creatinine measurement on the day of inclusion, performed as part of routine care).
5. Patient on ExtraCorporeal Membrane Oxygenation (ECMO) or ExtraCorporeal CO2 Removal
(ECCO2R).
6. Pregnant or breastfeeding women, patients under guardianship or trusteeship,
deprived of liberty
7. Patients who are moribund or for whom limitations of active therapies have been
decided.
8. Any condition, which in the opinion of the investigator, would not allow the
implementation of the study procedures.
Service Médecine Intensive Réanimation
Marseille, France
Investigator: Sami Hraiech
sami.hraiech@ap-hm.fr
Sami Hraiech
04 91 96 58 43 - 33
sami.hraiech@ap-hm.fr
François Cremieux, Study Director
AP-HM