Generic placeholder image

Current Respiratory Medicine Reviews


ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Review Article

VAP Causative Agents During COVID-19 Pandemic Era: Narrative Review

Author(s): Usha Rani Kandula*, Techane Sisay Tuji, Anwar Abdulwahed, Ketema Diriba, Kassech Leta and Birhanu Alemu

Volume 19, Issue 3, 2023

Published on: 09 August, 2023

Page: [202 - 217] Pages: 16

DOI: 10.2174/1573398X19666230727095317

Price: $65


Severe acute respiratory syndrome-Coronavirus-2(SARS-CoV-2) is very susceptible to transmission, and caused Coronavirus-19 (COVID-19), by spreading throughout the globe in early 2020 after starting in Wuhan, China in late 2019. Intensive care unit (ICU) COVID-19 patients experienced elevated fatality rates as a result of the COVID-19 pandemic. It is also anticipated that, the bacterial co-infection will cause a wave of subsequent bacterial illnesses. A significant infection causes morbidity in critically ill patients with COVID-19, is known as ventilator-associated pneumonia (VAP). A public health emergency has been proclaimed for COVID-19 by the World Health Organization (WHO). As per WHO, more than 113 million COVID-19 cases have been confirmed, and there have been about 2.5 million fatalities. Early research has shown that nosocomial pneumonia, particularly VAP, is significantly more common in people with severe SARS-CoV-2 infections. ICU patients frequently experience Acinetobacter baumannii (AbB) infections, while Aspergillus species are the fungi most frequently responsible for VAP. The review emphasizes the most prevalent microorganisms that caused infections to arise among hospitalized patients throughout the COVID-19 era. The literature identified AbB, Klebsiella pneumonia (KP), Aspergillus, Enterobacter cloacae (EC), Stenotrophomonas maltophilia (Spm), Staphylococcus aureus (SA), Streptococcus pneumonia (SP), Haemophilus influenza (HI), Enterococcus faecalis (EF), Escherichia coli (E. coli), Candida albicans (CA), Pseudomonas aeruginosa (PA), Serratia marcescens (SM), Burkholderia gladioli (BG), Mucor spp. (MS), Rhizopus spp. (RS), Cryptococcus neoformans (CN), Paracoccus yeei (PY). This review may help the health sectors to identify and focus on VAP causative organisms during COVID-19 pandemic period, for the early initiation of prompt therapeutic management.

Keywords: Ventilator associated pneumonia, VAP, Coronavirus-19, COVID-19, Severe acute respiratory syndrome, SARSCoV- 2, Pandemic, Microorganisms.

Graphical Abstract
Jamnani AN, Montazeri M, Mirzakhani M, Moosazadeh M, Haghighi M. Evaluation of bacterial coinfection and antibiotic resistance in patients with covid-19 under mechanical ventilation. SN Compr Clin Med 2022; 4(1): 19.
[] [PMID: 35013721]
Jerônimo LS, Esteves Lima RP, Suzuki TYU, Discacciati JAC, Bhering CLB. Oral candidiasis and covid-19 in users of removable dentures: is special oral care needed? Gerontology 2022; 68(1): 80-5.
[] [PMID: 33853063]
Kariyawasam RM, Julien DA, Jelinski DC, et al. Antimicrobial resistance (AMR) in COVID-19 patients: A systematic review and meta-analysis (November 2019-June 2021). Antimicrob Resist Infect Control 2022; 11(1): 45.
[] [PMID: 35255988]
Loyola-Cruz MÁ, Durán-Manuel EM, Cruz-Cruz C, Márquez-Valdelamar LM, Bravata-Alcántara JC, Cortés-Ortíz IA, et al. ESKAPE bacteria characterization reveals the presence of AbB and PA outbreaks in COVID-19/VAP patients. Am J Infect Control 2023; 51(7): 729-37.
[] [PMID: 36002081]
Camou F, Issa N, Hessamfar M, Guisset O, Mourissoux G, Pedeboscq S, et al. Risk of superinfection in critically ill COVID-19 patients receiving tocilizumab plus dexamethasone Available at:
Ćurčić M, Tarle M, Almahariq H, et al. Distribution of Pathogens and Predictive Values of Biomarkers of Inflammatory Response at ICU Admission on Outcomes of Critically Ill COVID-19 Patients with Bacterial Superinfections-Observations from National COVID-19 Hospital in Croatia. Diagnostics 2022; 12(9): 2069.
[] [PMID: 36140471]
Markovskaya Y, Gavioli EM, Cusumano JA, Glatt AE. (COVID- 19): Secondary bacterial infections and the impact on antimicrobial resistance during the COVID-19 pandemic. Antimicrob Steward Healthc Epidemiol. Coronavirus disease 2019.
de Carvalho Hessel Dias VM, Tuon F, de Jesus Capelo P, Telles JP, Fortaleza CMCB, Pellegrino Baena C. Trend analysis of carbapenem-resistant Gram-negative bacteria and antimicrobial consumption in the post-COVID-19 era: An extra challenge for healthcare institutions. J Hosp Infect 2022; 120: 43-7.
[] [PMID: 34808311]
Gunardi WD, Widelia GR, Pasaribu DM. Koinfeksi bakteri pada pasien covid - 19 di icu. J MedScientiae 2022.
Karolyi M, Pawelka E, Hind J, et al. Detection of bacteria via multiplex PCR in respiratory samples of critically ill COVID-19 patients with suspected HAP/VAP in the ICU. Wien Klin Wochenschr 2022; 134(9-10): 385-90.
[] [PMID: 34882256]
Chirumbolo S, Simonetti V, Franzini M, Valdenassi L, Bertossi D, Pandolfi S. Estimating coronavirus disease 2019 (COVID-19)-caused deaths in hospitals and healthcare units: Do hospital-acquired infections play a role? Comments with a proposal. Infect Control Hosp Epidemiol 2022; 43(6): 810-1.
[] [PMID: 33736720]
Lazev Z, Mohan N, Sharma B. Empiric antifungal coverage of the septic cirrhotic: A case report of Acinetobacter baumanii with concomitant fungal infection in a new cirrhotic Preprints
Martínez-Trejo A, Ruiz-Ruiz JM, Gonzalez-Avila LU, Saldaña-Padilla A, Hernández-Cortez C, Loyola-Cruz MA, et al. Evasion of antimicrobial activity in abb by target site modifications: an effective resistance mechanism. Int J Mol Sci 2022; 23(12): 6582.
[] [PMID: 35743027]
Hedberg P, Ternhag A, Giske CG, et al. Ventilator-associated lower respiratory tract bacterial infections in COVID-19 compared with non-COVID-19 patients. Crit Care Med 2022; 50(5): 825-36.
[] [PMID: 35148524]
Karaba SM, Hirsch EB, Heil EL. In a Pinch: Cefiderocol for CRAB Infections. Antimicrob Agents Chemother 2022; 66(5): e00065-22.
[] [PMID: 35400199]
Kashyap S, Sharma P, Capalash N. Tobramycin stress induced differential gene expression in AbB. Curr Microbiol 2022; 79(3): 88.
[] [PMID: 35129693]
Costa RL, Lamas CC, Simvoulidis LFN, et al. Secondary infections in a cohort of patients with COVID-19 admitted to an intensive care unit: Impact of gram-negative bacterial resistance. Rev Inst Med Trop São Paulo 2022; 64: e6.
[] [PMID: 35137900]
Giamarellou H, Karaiskos I. Current and potential therapeutic options for infections caused by difficult-to-treat and pandrug resistant gram-negative bacteria in critically ill patients. Antibiotics 2022; 11(8): 1009.
[] [PMID: 35892399]
Mędrzycka-Dąbrowska W, Lange S, Zorena K, et al. Carbapenemresistant klebsiella pneumoniae infections in icu covid-19 patients— a scoping review. J Clin Med 2021; 10(10): 2067.
[] [PMID: 34066031]
Kurra N, Woodard PI, Gandrakota N, et al. Opportunistic infections in covid-19: a systematic review and meta-analysis. Cureus 2022; 14(3): e23687.
[] [PMID: 35505698]
Rayeesa Faheem S, Srinivas T, Sadhana Y. A Comparative study of <em>acinetobacter</em> infections in covid and non-covid patients. Journal of Infectious Diseases and Epidemiology 2022; 8(2)
Rollas K, Ersan G, Emgin O, Caliskan T, Yavuz T, Sarac O. Evaluation of microorganisms isolated from endotracheal aspirate cultures in patients with and without covid-19 in the intensive care unit: single-centre retrospective analysis J Crit Intensive Care 2022; 13(2): 66-72.
Russo A, Gavaruzzi F, Ceccarelli G, Borrazzo C, Oliva A, Alessandri F, et al. Multidrug-resistant AbB infections in COVID-19 patients hospitalized in intensive care unit. Infection 2022; 50(1): 83-92.
[] [PMID: 34176088]
Santoso P, Sung M, Hartantri Y, et al. MDr pathogens organisms as risk factor of mortality in secondary pulmonary bacterial infections among covid-19 patients: observational studies in two referral hospitals in west java, indonesia. Int J Gen Med 2022; 15: 4741-51.
[] [PMID: 35571285]
Shbaklo N, Corcione S, Vicentini C, et al. An Observational study of mdr hospital-acquired infections and antibiotic use during covid-19 pandemic: a call for antimicrobial stewardship programs. Antibiotics 2022; 11(5): 695.
[] [PMID: 35625339]
Velásquez-Garcia L, Mejia-Sanjuanelo A, Viasus D, Carratalà J. Causative agents of ventilator-associated pneumonia and resistance to antibiotics in covid-19 patients: a systematic review. Biomedicines 2022; 10(6): 1226.
[] [PMID: 35740246]
Fortún J. Diagnostic and therapeutic approach to fungal pneumonia in the critically ill patient. Rev Esp Quimioter 2022; 35(Suppl1)(Suppl. 1): 97-103.
[] [PMID: 35488836]
Fiema M, Wlodarczyk A, Wojkowska-Mach J, Garlicki J, Gregorczyk-Maga I. Atypical presentation of aspergillus niger infection in the oral cavity as a prediction of invasive pulmonary aspergillosis in a patient with covid-19: case report and literature review. Microorganisms 2022; 10(8): 1630.
[] [PMID: 36014048]
Seyedjavadi SS, Bagheri P, Nasiri MJ, Razzaghi-Abyaneh M, Goudarzi M. Fungal infection in co-infected patients with covid-19: an overview of case reports/case series and systematic review. Front Microbiol 2022; 13: 888452.
[] [PMID: 35875562]
Viciani E, Gaibani P, Castagnetti A, et al. Critically ill patients with COVID-19 show lung fungal dysbiosis with reduced microbial diversity in patients colonized with Candida spp. Int J Infect Dis 2022; 117: 233-40.
[] [PMID: 35150910]
Gomez-Simmonds A, Annavajhala MK, McConville TH, et al. Carbapenemase-producing Enterobacterales causing secondary infections during the COVID-19 crisis at a New York City hospital. J Antimicrob Chemother 2021; 76(2): 380-4.
[] [PMID: 33202023]
Pintado V, Ruiz-Garbajosa P, Escudero-Sanchez R, et al. Carbapenemase-producing Enterobacterales infections in COVID-19 patients. Infect Dis 2022; 54(1): 36-45.
[] [PMID: 34382910]
Zuglian G, Ripamonti D, Tebaldi A, et al. The changing pattern of bacterial and fungal respiratory isolates in patients with and without COVID-19 admitted to intensive care unit. BMC Infect Dis 2022; 22(1): 185.
[] [PMID: 35196993]
Prabha GR, Rao SR. Study on the incidence of nosocomialinfections in COVID19 patients inatertiary care. Hospital 2022; 9(4): 6.
Roshdy EM, Attia E, Samy S, et al. The impact of covid-19 pandemic on health care-associated infections in intensive care units: results from the egypt national health care-associated infections surveillance, 2019-2020. Iproceedings 2022; 8(1): e36605.
Russo A, Olivadese V, Trecarichi EM, Torti C. Bacterial Ventilator-Associated Pneumonia in COVID-19 Patients: Data from the Second and Third Waves of the Pandemic. J Clin Med 2022; 11(9): 2279.
[] [PMID: 35566405]
Tanaka S, Yamamoto K, Hagiya H, Hasegawa K, Otsuka F. Threat of sa pneumonia in severe covid-19 patients. Cureus 2022; 14(2)
[PMID: 35345748]
Vacheron CH, Lepape A, Savey A, et al. Increased incidence of ventilator-acquired pneumonia in coronavirus disease 2019 patients: A multicentric cohort study. Crit Care Med 2022; 50(3): 449-59.
[] [PMID: 34637422]
van Charante F, Wieme A, Rigole P, et al. Microbial diversity and antimicrobial susceptibility in endotracheal tube biofilms recovered from mechanically ventilated COVID-19 patients. Biofilm 2022; 4: 100079.
[] [PMID: 35720435]
Weidmann MD, Berry GJ, Zucker JE, Huang S, Sobieszczyk ME, Green DA. Bacterial pneumonia and respiratory culture utilization among hospitalized patients with and without covid-19 in a new york city hospital. J Clin Microbiol 2022; 60(7): e00174-22.
[] [PMID: 35642519]
Porto APM, Borges IC, Buss L, Machado A, Bassetti BR, Cocentino B, et al. Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study. Infect Control Hosp Epidemiol 2022; 1-7.
[PMID: 35300742]
Rajendraprasad S, Creech ZA, Truong GTD, Nguyen T, Addula M, Mendoza N, et al. Fatal case of burkholderia gladioli pneumonia in a patient with covid-19. Ochsner J 2022; 22(4): 349-52.
[] [PMID: 36561098]
Štingl J, Hylmarová J, Lengerová M, Maláska J, Stašek J. Cryptococcal pneumonia: an unusual complication in a covid-19 patient. Diagnostics 2022; 12(8): 1944.
[] [PMID: 36010294]
Burastero GJ, Orlando G, Santoro A, et al. Ceftazidime/Avibactam in Ventilator-Associated Pneumonia Due to Difficult-to-Treat Non-Fermenter Gram-Negative Bacteria in COVID-19 Patients: A Case Series and Review of the Literature. Antibiotics 2022; 11(8): 1007.
[] [PMID: 35892396]
Tetaj N, Capone A, Stazi GV, et al. Epidemiology of ventilator-associated pneumonia in ICU COVID-19 patients: An alarming high rate of multidrug-resistant bacteria. Journal of Anesthesia, Analgesia and Critical Care 2022; 2(1): 36.
Scaravilli V, Guzzardella A, Madotto F, et al. Impact of dexamethasone on the incidence of ventilator-associated pneumonia in mechanically ventilated COVID-19 patients: A propensity-matched cohort study. Crit Care 2022; 26(1): 176.
[] [PMID: 35698155]
Porto APM, Borges IC, Buss L, Machado A, Bassetti BR, Cocentino B, et al. Healthcare-associated infections on the ICU in 21 Brazilian hospitals during the early months of the COVID-19 pandemic: An ecological study. Infect Control Hosp Epidemiol 2022; 1-37.
Montrucchio G, Corcione S, Lupia T, Shbaklo N, Olivieri C, Poggioli M, et al. The burden of carbapenem-resistant abb in icu covid-19 patients: a regional experience. J Clin Med 2022; 11(17): 5208.
[] [PMID: 36079137]
Arici N, Özgültekı̇n A, Kansak N, Adaletı̇ R, Ankarali H, Aksaray S. Secondary infections in covid-19 patients hospitalized in a tertiary hospital. Online Türk Sağlık Bilimleri Dergisi 2022; 7(1): 99- 105.
Parikh AD, Vadhar BD, Thompson M, Obi ON. Double Trouble: Hospital-Acquired Infections in Critically-Ill COVID-19 Patients. In: C62 EXPANDING OUR INSIGHT INTO COVID-19 2022.
Erami M, Raiesi O, Momen-Heravi M, et al. Clinical impact of Candida respiratory tract colonization and acute lung infections in critically ill patients with COVID-19 pneumonia. Microb Pathog 2022; 166: 105520.
[] [PMID: 35405278]
Zand F, Vakili H, Asmarian N, Masjedi M, Sabetian G, Nikandish R, et al. Unintended Impact of Covid-19 Pandemic on The Rate Of Catheter Related Nosocomial Infections and Prevalence of Multiple Drug Resistance Pathogens in Three Intensive Care Units Not Allocated to Covid-19 Patients in A Large Teaching Hospital. BMC Infect Dis 2023; 23(1): 11.
[] [PMID: 36609225]
Avkan-Oğuz V, Çelİk M, Eren-Kutsoylu OÖ, et al. Fungal colonization and infections in patients with COVID-19 in intensive care units: A real-life experience at a tertiary-care hospital. Respir Med Res 2022; 82: 100937.
[] [PMID: 35792466]
Benedetti P, Pegoraro M, Novello E, Romualdi C, Manfrin V, Livermore DM. Antibiotic Resistance in Respiratory Bacterial Isolates From Critical Care Patients Infected With Sars-CoV2 Available at:
Meschiari M, Onorato L, Bacca E, et al. Long-Term Impact of the COVID-19 Pandemic on In-Hospital Antibiotic Consumption and Antibiotic Resistance: A Time Series Analysis (2015-2021). Antibiotics 2022; 11(6): 826.
[] [PMID: 35740232]
Bahçe YG, Acer Ö, Özüdoğru O. Evaluation of bacterial agents isolated from endotracheal aspirate cultures of Covid-19 general intensive care patients and their antibiotic resistance profiles compared to pre-pandemic conditions. Microb Pathog 2022; 164: 105409.
[] [PMID: 35041973]
Fumagalli J, Panigada M, Klompas M, Berra L. Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients. Curr Opin Crit Care 2022; 28(1): 74-82.
[] [PMID: 34932525]
Qu J, Cai Z, Duan X, Zhang H, Cheng H, Han S, et al. PA modulates alginate biosynthesis and type VI secretion system in two critically ill COVID-19 patients. Cell Biosci 2022; 12(1): 14.
[] [PMID: 35139898]
Marcoux D, Etienne I, Van Muylem A, et al. A Retrospective, Monocentric Study Comparing Co and Secondary Infections in Critically Ill COVID-19 and Influenza Patients. Antibiotics 2022; 11(6): 704.
[] [PMID: 35740112]
Dutta S, Kumar P, Paulpandian R, et al. Relationship Between COVID-19 Lockdown and Epidemiology of Neonatal Sepsis. Pediatr Infect Dis J 2022; 41(6): 482-9.
[] [PMID: 35195565]
Shah S, Karlapalem C, Patel P, Madan N. Streptococcus pneumoniae Coinfection in COVID-19 in the Intensive Care Unit: A Series of Four Cases. Case Rep Crit Care 2022; 2022: 1-5.
[] [PMID: 35991582]
İpek S, Şahin A, Gungor S, et al. Nosocomial Infections in Non- COVID-19 Pediatric Patients Prior to and During the Pandemic in a Pediatric Intensive Care Unit. Cureus 2022; 14(1): e21451.
[] [PMID: 35223235]
Villegas J, Gutiérrez J, Angel J, Villegas A, Gutiérrez J, Quirino S, et al. Antibiotic resistance in infections associated with health care in COVID-19 pandemic. An Real Acad Nac Farm 2022; 88: 123-30.
Ceparano M, Baccolini V, Migliara G, Isonne C, Renzi E, Tufi D, et al. AbB isolates from covid-19 patients in a hospital intensive care unit: molecular typing and risk factors. Microorganisms 2022; 10(4): 722.
[] [PMID: 35456774]
Mete B, Kurt AF, Urkmez S, Demirkiran O, Can G, Dumanli GY, et al. The bad bug is back: abb bacteremia outbreak during the covid-19 pandemic in an intensive care unit. Niger J Clin Pract 2022; 25(5): 702.
[] [PMID: 35593616]
Singh G. Microbial Pattern and Antibiotic Resistance of Severe Pneumonia in A National Referral Hospital in Indonesia 2022.
Najeeb H, Siddiqui SA, Anas Z, et al. The Menace of Candida auris Epidemic Amidst the COVID-19 Pandemic: A Systematic Review. Diseases 2022; 10(3): 58.
[] [PMID: 36135214]
Kurnia D. Correlation between Multidrug Resistance Infection with Clinical Outcomes of Critically ill Patients with COVID-19 Admitted to an Intensive Care at RSUP Available at:
Barnes D, Malkhasian Y, Pyarali F, Rampolla R. Description and characterization of intraoperative bacterial cultures during lung transplant surgery. J Heart Lung Transplant 2022; 41(4): S395-6.

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy