Pulmonary infections complicating acute respiratory distress syndrome

Charles-Edouard Luyt (1, 2) , Lila Bouadma (3, 4) , Andrew Conway Morris (5, 6) , Jayesh A Dhanani (7) , Marin Kollef (8) , Jeffrey Lipman (7) , Ignacio Martin-Loeches (9) , Saad Nseir (10) , Otavio T Ranzani (11, 12) , Antoine Roquilly (13, 14) , Matthieu Schmidt (2, 1) , Antoni Torres (15) , Jean-François Timsit (3, 4)

1 Institut de cardiologie [CHU Pitié-Salpêtrière]
2 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
3 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
4 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
5 Addenbrooke's Hospital
6 CAM - University of Cambridge [UK]
7 UQ [All campuses : Brisbane, Dutton Park Gatton, Herston, St Lucia and other locations] - The University of Queensland
8 Washington University School of Medicine in St. Louis
9 Trinity College Dublin
10 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
11 Universidade Federal de São Paulo
12 ISGlobal - Instituto de Salud Global - Institute For Global Health [Barcelona]
13 EA 3826 - Thérapeutiques cliniques et expérimentales des infections (EA 3826)
14 CHU Nantes - Centre Hospitalier Universitaire de Nantes
15 UB - Universitat de Barcelona

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.

Mots clés: Acute respiratory distress syndrome; Ventilator-associated pneumonia; Microbiota; Prevention; Nebulization

Domaines: Médecine humaine et pathologie

Charles-Edouard Luyt, Lila Bouadma, Andrew Conway Morris, Jayesh A Dhanani, Marin Kollef, et al.. Pulmonary infections complicating acute respiratory distress syndrome. Intensive Care Medicine, 2020, ⟨10.1007/s00134-020-06292-z⟩. ⟨hal-03024892⟩