TY - JOUR
T1 - Pulmonary infections complicating ARDS
AU - Luyt, Charles Edouard
AU - Bouadma, Lila
AU - Morris, Andrew Conway
AU - Dhanani, Jayesh A.
AU - Kollef, Marin
AU - Lipman, Jeffrey
AU - Martin-Loeches, Ignacio
AU - Nseir, Saad
AU - Ranzani, Otavio T.
AU - Roquilly, Antoine
AU - Schmidt, Matthieu
AU - Torres, Antoni
AU - Timsit, Jean François
N1 - Funding Information:
C-EL reports personal fees from Merck Sharp and Dohme, Thermo Fisher Brahms, Biomérieux, Carmat, Bayer Healthcare, Aerogen and grants from Bayer Healthcare, outside the scope of the submitted work. ACM is supported by a Clinical Research Career Development Fellowship from the Wellcome Trust (WT 2055214/Z/16/Z). MK is supported by the Barnes-Jewish Hospital Foundation. IM-L received lecture fees from Gilead and Merck. SN reports personal fees from Merck Sharp and Dohme, Gilead, Pfizer, Biomérieux, and Bio Rad, outside the scope of the submitted work. OTR declares no competing interests. He is funded through a Sara Borrell grant from the Instituto de Salud Carlos III (CD19/00110). MS reports lecture fees from Maquet, Getinge and Fresenius, outside the scope of the submitted work. AT reports personal fees from Arsanis, Aridis, Bayer, Roche, Polyphor, GSK and Pfizer outside the submitted work. J-FT declares participation in adboard for MSD, Pfizer, Gilead, Paratek, Bayer, Medimune, and Nabriva; lectures for MSD, Pfizer, Biomerieux and research grants to his research team from MSD, Pfizer, Thermofisher, outside the submitted work. J-FT is the PI of academic research project MULTICAP (PHRC N 16-0595 NCT 03452826) on molecular methods for diagnosing severe pneumonia and is PI of an academic research comparing antimicrobial regimens in severe sepsis (BICCS PHRC-N 18-0316 not yet recruiting), both outside the submitted work. Other authors declare that they have no conflicts of interest to declare in relation with the current manuscript.
Funding Information:
JD acknowledges the MNHHS Clinician Research Fellowship 2020.
Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2020/12
Y1 - 2020/12
N2 - Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients. Diagnosing pulmonary infection in ARDS patients is challenging, and requires a combination of clinical, biological and microbiological criteria. The role of modern tools (e.g., molecular methods, metagenomic sequencing, etc.) remains to be evaluated in this setting. One of the challenges of antimicrobial treatment is antibiotics diffusion into the lungs. Although targeted delivery of antibiotics using nebulization may be interesting, their place in ARDS patients remains to be explored. The use of extracorporeal membrane oxygenation in the most severe patients is associated with a high rate of infection and raises several challenges, diagnostic issues and pharmacokinetics/pharmacodynamics changes being at the top. Prevention of pulmonary infection is a key issue in ARDS patients, but there is no specific measure for these high-risk patients. Reinforcing preventive measures using bundles seems to be the best option.
AB - Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients. Diagnosing pulmonary infection in ARDS patients is challenging, and requires a combination of clinical, biological and microbiological criteria. The role of modern tools (e.g., molecular methods, metagenomic sequencing, etc.) remains to be evaluated in this setting. One of the challenges of antimicrobial treatment is antibiotics diffusion into the lungs. Although targeted delivery of antibiotics using nebulization may be interesting, their place in ARDS patients remains to be explored. The use of extracorporeal membrane oxygenation in the most severe patients is associated with a high rate of infection and raises several challenges, diagnostic issues and pharmacokinetics/pharmacodynamics changes being at the top. Prevention of pulmonary infection is a key issue in ARDS patients, but there is no specific measure for these high-risk patients. Reinforcing preventive measures using bundles seems to be the best option.
KW - Acute respiratory distress syndrome
KW - Microbiota
KW - Nebulization
KW - Prevention
KW - Ventilator-associated pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85095830889&partnerID=8YFLogxK
U2 - 10.1007/s00134-020-06292-z
DO - 10.1007/s00134-020-06292-z
M3 - Review article
C2 - 33175277
AN - SCOPUS:85095830889
VL - 46
SP - 2168
EP - 2183
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 12
ER -