The Resistance Paradox in COVID-19 Ventilator-Associated Pneumonia: A Retrospective Study on Rapid Molecular Stewardship

DOI record: { "DOI": "10.3390/antibiotics15030236", "ISSN": [ "2079-6382" ], "URL": "http://dx.doi.org/10.3390/antibiotics15030236", "abstract": "<jats:p>Background/Objectives: The COVID-19 pandemic complicated the diagnosis of Ventilator-Associated Pneumonia (VAP), leading to empiric antibiotic overuse due to the difficulty in distinguishing viral progression from bacterial superinfection. However, it remains unclear whether COVID-19-associated VAP displays a distinct antimicrobial resistance profile compared to classical VAP. Methods: This monocentric, retrospective cohort study primarily investigated differences in clinical phenotypes and antibiotic resistance profiles between patients with VAP-COVID (n = 26) and non-COVID-VAP (n = 26). Logistic regression was used to identify factors associated with the COVID-19 phenotype and predictors of antimicrobial resistance. As a secondary objective, we evaluated the diagnostic efficacy of a multiplex Point-of-Care PCR (POC-PCR) system (n = 22) compared to standard culture (n = 26) regarding turnaround time and resistance detection. Results: Patients with VAP-COVID exhibited significantly higher resistance rates to carbapenems (76.9% vs. 50%, p = 0.04) and fluoroquinolones (88.5% vs. 61.5%, p = 0.02) despite fewer traditional risk factors at admission. The clinical profile of the VAP-COVID group was distinguished by a significantly lower incidence of parapneumonic pleural effusion (19.2% vs. 84.6%, p &lt; 0.001) and a higher median Neutrophil-to-Lymphocyte Ratio (41.36 vs. 9.63, p &lt; 0.001). Regarding diagnostic speed, POC-PCR significantly reduced the time to result validation compared to standard culture (~1 h vs. ~62.5 h, p &lt; 0.001). Conclusions: VAP in COVID-19 patients presents a distinct microbiological profile characterized by higher antimicrobial resistance. In this context, the integration of rapid molecular diagnostics may support earlier microbiological guidance compared to standard methods.</jats:p>", "alternative-id": [ "antibiotics15030236" ], "author": [ { "affiliation": [ { "name": "2nd Department of Anesthesia and Intensive Care, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania" }, { "name": "Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania" } ], "family": "Bălan", "given": "Andrei Mihai", "sequence": "first" }, { "ORCID": "https://orcid.org/0000-0002-0774-020X", "affiliation": [ { "name": "2nd Department of Anesthesia and Intensive Care, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania" }, { "name": "Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania" } ], "authenticated-orcid": false, "family": "Magdaș", "given": "Tudor-Mihai", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0001-7685-0085", "affiliation": [ { "name": "Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania" } ], "authenticated-orcid": false, "family": "Urda-Cîmpean", "given": "Andrada Elena", "sequence": "additional" }, { "affiliation": [ { "name": "2nd Department of Anesthesia and Intensive Care, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania" }, { "name": "Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania" } ], "family": "Bodolea", "given": "Constantin", "sequence": "additional" }, { "affiliation": [ { "name": "2nd Department of Anesthesia and Intensive Care, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania" }, { "name": "Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania" } ], "family": "Nemeș", "given": "Andrada", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-2656-3234", "affiliation": [ { "name": "Geriatrics—Gerontology, Department 5—Medical Specialties, Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania" } ], "authenticated-orcid": false, "family": "Avram", "given": "Lucreția", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-1627-9670", "affiliation": [ { "name": "Department of Internal Medicine, 5th Medical Clinic, Clinical Municipal Hospital, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania" } ], "authenticated-orcid": false, "family": "Crișan", "given": "Dana", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-2455-9231", "affiliation": [ { "name": "2nd Department of Anesthesia and Intensive Care, “Iuliu Hatieganu” University of Medicine and Pharmacy, 8 Victor Babeş Street, 400012 Cluj-Napoca, Romania" }, { "name": "Emergency Department, The Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania" } ], "authenticated-orcid": false, "family": "Trancă", "given": "Sebastian", "sequence": "additional" } ], "container-title": "Antibiotics", "container-title-short": "Antibiotics", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2026, 2, 24 ] ], "date-time": "2026-02-24T12:19:23Z", "timestamp": 1771935563000 }, "deposited": { "date-parts": [ [ 2026, 2, 24 ] ], "date-time": "2026-02-24T12:56:56Z", "timestamp": 1771937816000 }, "indexed": { "date-parts": [ [ 2026, 2, 24 ] ], "date-time": "2026-02-24T13:56:30Z", "timestamp": 1771941390120, "version": "3.50.1" }, "is-referenced-by-count": 0, "issue": "3", "issued": { "date-parts": [ [ 2026, 2, 24 ] ] }, "journal-issue": { "issue": "3", "published-online": { "date-parts": [ [ 2026, 3 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2026, 2, 24 ] ], "date-time": "2026-02-24T00:00:00Z", "timestamp": 1771891200000 } } ], "link": [ { "URL": "https://www.mdpi.com/2079-6382/15/3/236/pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1968", "original-title": [], "page": "236", "prefix": "10.3390", "published": { "date-parts": [ [ 2026, 2, 24 ] ] }, "published-online": { "date-parts": [ [ 2026, 2, 24 ] ] }, "publisher": "MDPI AG", "reference": [ { "key": "ref_1", "unstructured": "(2022). COVID-19 Excess Mortality Collaborators. Estimating Excess Mortality Due to the COVID-19 Pandemic: A Systematic Analysis of COVID-19-Related Mortality, 2020–21. Lancet, 399, 1513–1536." }, { "key": "ref_2", "unstructured": "Janes, S.M. (2022). Pneumonia—Overview. Encyclopedia of Respiratory Medicine, Academic Press. [2nd ed.]." }, { "DOI": "10.1007/s00134-020-05980-0", "article-title": "Ventilator-Associated Pneumonia in Adults: A Narrative Review", "author": "Papazian", "doi-asserted-by": "crossref", "first-page": "888", "journal-title": "Intensive Care Med.", "key": "ref_3", "volume": "46", "year": "2020" }, { "DOI": "10.1183/13993003.00582-2017", "article-title": "International ERS/ESICM/ESCMID/ALAT Guidelines for the Management of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia", "author": "Torres", "doi-asserted-by": "crossref", "first-page": "1700582", "journal-title": "Eur. Respir. J.", "key": "ref_4", "volume": "50", "year": "2017" }, { "DOI": "10.1093/cid/ciw353", "article-title": "Management of Adults with Hospital-Acquired and Ventilator-Associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society", "author": "Kalil", "doi-asserted-by": "crossref", "first-page": "e61", "journal-title": "Clin. Infect. Dis.", "key": "ref_5", "volume": "63", "year": "2016" }, { "article-title": "Epidemiology of ICU-Acquired Pneumonia", "author": "Ferrer", "first-page": "325", "journal-title": "Curr. Opin. Crit. Care", "key": "ref_6", "volume": "24", "year": "2018" }, { "DOI": "10.1007/s00134-019-05859-9", "article-title": "What Is New in Non-Ventilated ICU-Acquired Pneumonia?", "author": "Saied", "doi-asserted-by": "crossref", "first-page": "488", "journal-title": "Intensive Care Med.", "key": "ref_7", "volume": "46", "year": "2020" }, { "DOI": "10.1016/j.ijid.2021.10.001", "article-title": "COVID-19 and Antimicrobial Stewardship: Lessons Learned, Best Practices, and Future Implications", "author": "Pierce", "doi-asserted-by": "crossref", "first-page": "103", "journal-title": "Int. J. Infect. Dis.", "key": "ref_8", "volume": "113", "year": "2021" }, { "DOI": "10.1017/ash.2022.34", "article-title": "Leveraging Antimicrobial Stewardship Programs in Response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency", "author": "Joerger", "doi-asserted-by": "crossref", "first-page": "e41", "journal-title": "Antimicrob. Steward. Healthc. Epidemiol.", "key": "ref_9", "volume": "2", "year": "2022" }, { "DOI": "10.5152/TJAR.2022.21310", "article-title": "Comparison of Ventilator-Associated Pneumonia in Patients Admitted to Intensive Care for COVID-19 Versus Other Reasons: A Single-Centered Study", "author": "Akman", "doi-asserted-by": "crossref", "first-page": "S22", "journal-title": "Turk. J. Anaesthesiol. Reanim.", "key": "ref_10", "volume": "50", "year": "2022" }, { "DOI": "10.1097/CCM.0000000000005297", "article-title": "Increased Incidence of Ventilator-Acquired Pneumonia in Coronavirus Disease 2019 Patients: A Multicentric Cohort Study", "author": "Vacheron", "doi-asserted-by": "crossref", "first-page": "449", "journal-title": "Crit. Care Med.", "key": "ref_11", "volume": "50", "year": "2022" }, { "article-title": "Ventilator-Associated Pneumonia among SARS-CoV-2 Acute Respiratory Distress Syndrome Patients", "author": "Fumagalli", "first-page": "74", "journal-title": "Curr. Opin. Crit. Care", "key": "ref_12", "volume": "28", "year": "2022" }, { "DOI": "10.3390/jcm14031000", "doi-asserted-by": "crossref", "key": "ref_13", "unstructured": "Hlinkova, S., Moraucikova, E., Strzelecka, A., Mrazova, M., and Littva, V. (2025). Ventilator-Associated Pneumonia in Intensive Care Units: A Comparison of Pre-Pandemic and COVID-19 Periods. J. Clin. Med., 14." }, { "DOI": "10.3390/antibiotics10050545", "doi-asserted-by": "crossref", "key": "ref_14", "unstructured": "Ippolito, M., Misseri, G., Catalisano, G., Marino, C., Ingoglia, G., Alessi, M., Consiglio, E., Gregoretti, C., Giarratano, A., and Cortegiani, A. (2021). Ventilator-Associated Pneumonia in Patients with COVID-19: A Systematic Review and Meta-Analysis. Antibiotics, 10." }, { "DOI": "10.1186/s40560-020-00499-4", "article-title": "Factors Influencing Liberation from Mechanical Ventilation in Coronavirus Disease 2019: Multicenter Observational Study in Fifteen Italian ICUs", "author": "Gamberini", "doi-asserted-by": "crossref", "first-page": "80", "journal-title": "J. Intensive Care", "key": "ref_15", "volume": "8", "year": "2020" }, { "DOI": "10.1007/s00134-020-06323-9", "article-title": "Relationship between SARS-CoV-2 Infection and the Incidence of Ventilator-Associated Lower Respiratory Tract Infections: A European Multicenter Cohort Study", "author": "Povoa", "doi-asserted-by": "crossref", "first-page": "188", "journal-title": "Intensive Care Med.", "key": "ref_16", "volume": "47", "year": "2021" }, { "DOI": "10.1186/s13613-020-00775-4", "article-title": "Ventilator-Associated Pneumonia in Patients with SARS-CoV-2-Associated Acute Respiratory Distress Syndrome Requiring ECMO: A Retrospective Cohort Study", "author": "Luyt", "doi-asserted-by": "crossref", "first-page": "158", "journal-title": "Ann. Intensive Care", "key": "ref_17", "volume": "10", "year": "2020" }, { "article-title": "Comparative Evaluation of Ventilator-Associated Pneumonia in Critically Ill COVID-19 and Patients Infected with Other Corona Viruses: A Systematic Review and Meta-Analysis", "author": "Jain", "first-page": "1610", "journal-title": "Monaldi Arch. Chest Dis.", "key": "ref_18", "volume": "92", "year": "2021" }, { "DOI": "10.1186/s13054-021-03493-w", "article-title": "Epidemiology and Microbiology of Ventilator-Associated Pneumonia in COVID-19 Patients: A Multicenter Retrospective Study in 188 Patients in an Un-Inundated French Region", "author": "Blonz", "doi-asserted-by": "crossref", "first-page": "72", "journal-title": "Crit. Care", "key": "ref_19", "volume": "25", "year": "2021" }, { "article-title": "Personal Protective Equipment Use by Healthcare Workers in Intensive Care Unit During the Early Phase of COVID-19 Pandemic in Italy: A Secondary Analysis of the PPE-SAFE Survey", "author": "Ippolito", "first-page": "2049936121998562", "journal-title": "Ther. Adv. Infect. Dis.", "key": "ref_20", "volume": "8", "year": "2021" }, { "DOI": "10.1007/s00134-015-4167-5", "article-title": "Ventilator-Associated Pneumonia in ARDS Patients: The Impact of Prone Positioning. A Secondary Analysis of the PROSEVA Trial", "author": "Ayzac", "doi-asserted-by": "crossref", "first-page": "871", "journal-title": "Intensive Care Med.", "key": "ref_21", "volume": "42", "year": "2016" }, { "DOI": "10.1056/NEJMoa1214103", "article-title": "Prone Positioning in Severe Acute Respiratory Distress Syndrome", "author": "Reignier", "doi-asserted-by": "crossref", "first-page": "2159", "journal-title": "N. Engl. J. Med.", "key": "ref_22", "volume": "368", "year": "2013" }, { "DOI": "10.1016/j.jiac.2021.01.011", "article-title": "Ventilator-Associated Bacterial Pneumonia in Coronavirus 2019 Disease, a Retrospective Monocentric Cohort Study", "author": "Moretti", "doi-asserted-by": "crossref", "first-page": "826", "journal-title": "J. Infect. Chemother.", "key": "ref_23", "volume": "27", "year": "2021" }, { "DOI": "10.1016/S2213-2600(20)30370-2", "article-title": "Pathophysiology of COVID-19-Associated Acute Respiratory Distress Syndrome: A Multicentre Prospective Observational Study", "author": "Grasselli", "doi-asserted-by": "crossref", "first-page": "1201", "journal-title": "Lancet Respir. Med.", "key": "ref_24", "volume": "8", "year": "2020" }, { "DOI": "10.21203/rs.3.rs-380803/v1", "doi-asserted-by": "crossref", "key": "ref_25", "unstructured": "Tsitsiklis, A., Zha, B.S., Byrne, A., DeVoe, C., Rackaityte, E., Levan, S., Sunshine, S., Mick, E., Ghale, R., and Love, C. (2021). Impaired Immune Signaling and Changes in the Lung Microbiome Precede Secondary Bacterial Pneumonia in COVID-19. medRxiv, 2021.03.23.21253487." }, { "DOI": "10.1016/j.chom.2020.04.017", "article-title": "Heightened Innate Immune Responses in the Respiratory Tract of COVID-19 Patients", "author": "Zhou", "doi-asserted-by": "crossref", "first-page": "883", "journal-title": "Cell Host Microbe", "key": "ref_26", "volume": "27", "year": "2020" }, { "DOI": "10.3389/fimmu.2018.01421", "doi-asserted-by": "crossref", "key": "ref_27", "unstructured": "Crane, M.J., Lee, K.M., FitzGerald, E.S., and Jamieson, A.M. (2018). Surviving Deadly Lung Infections: Innate Host Tolerance Mechanisms in the Pulmonary System. Front. Immunol., 9." }, { "DOI": "10.1016/j.chom.2020.04.009", "article-title": "Complex Immune Dysregulation in COVID-19 Patients with Severe Respiratory Failure", "author": "Netea", "doi-asserted-by": "crossref", "first-page": "992", "journal-title": "Cell Host Microbe", "key": "ref_28", "volume": "27", "year": "2020" }, { "DOI": "10.3389/fphar.2022.945892", "doi-asserted-by": "crossref", "key": "ref_29", "unstructured": "Deng, J., Li, F., Zhang, N., and Zhong, Y. (2022). Prevention and Treatment of Ventilator-Associated Pneumonia in COVID-19. Front. Pharmacol., 13." }, { "DOI": "10.1016/j.cmi.2020.07.016", "article-title": "Bacterial Co-Infection and Secondary Infection in Patients with COVID-19: A Living Rapid Review and Meta-Analysis", "author": "Langford", "doi-asserted-by": "crossref", "first-page": "1622", "journal-title": "Clin. Microbiol. Infect.", "key": "ref_30", "volume": "26", "year": "2020" }, { "DOI": "10.1097/QCO.0000000000000817", "article-title": "How Common Is Ventilator-Associated Pneumonia after Coronavirus Disease 2019?", "author": "Wicky", "doi-asserted-by": "crossref", "first-page": "170", "journal-title": "Curr. Opin. Infect. Dis.", "key": "ref_31", "volume": "35", "year": "2022" }, { "DOI": "10.1513/AnnalsATS.202003-188ST", "article-title": "Antibiotic Stewardship in the Intensive Care Unit: An Official American Thoracic Society Workshop Report in Collaboration with the AACN, CHEST, CDC, and SCCM", "author": "Wunderink", "doi-asserted-by": "crossref", "first-page": "531", "journal-title": "Ann. Am. Thorac. Soc.", "key": "ref_32", "volume": "17", "year": "2020" }, { "DOI": "10.1093/eurpub/ckaf167", "article-title": "The Impact of the COVID-19 Pandemic on the Antibiotic Consumption and Resistance in Montenegro", "author": "Mijovic", "doi-asserted-by": "crossref", "first-page": "1295", "journal-title": "Eur. J. Public Health", "key": "ref_33", "volume": "35", "year": "2025" }, { "DOI": "10.7326/ANNALS-24-03078", "article-title": "Impact of the COVID-19 Pandemic on Antibiotic Resistant Infection Burden in U.S. Hospitals: Retrospective Cohort Study of Trends and Risk Factors", "author": "Yek", "doi-asserted-by": "crossref", "first-page": "796", "journal-title": "Ann. Intern. Med.", "key": "ref_34", "volume": "178", "year": "2025" }, { "DOI": "10.1016/j.jiph.2022.12.022", "article-title": "Impact of COVID-19 Pandemic on Multidrug Resistant Gram Positive and Gram Negative Pathogens: A Systematic Review", "author": "Abubakar", "doi-asserted-by": "crossref", "first-page": "320", "journal-title": "J. Infect. Public Health", "key": "ref_35", "volume": "16", "year": "2023" }, { "DOI": "10.1016/j.cmi.2024.05.014", "article-title": "European Society of Clinical Microbiology and Infectious Diseases Guidelines for Antimicrobial Stewardship in Emergency Departments", "author": "Schoffelen", "doi-asserted-by": "crossref", "first-page": "1384", "journal-title": "Clin. Microbiol. Infect.", "key": "ref_36", "volume": "30", "year": "2024" }, { "key": "ref_37", "unstructured": "European Commission (2017). Commission Notice—EU Guidelines for the Prudent Use of Antimicrobials in Human Health. Off. J. Eur. Union, C 212, 1–12." }, { "DOI": "10.1093/ofid/ofac437", "article-title": "Detection of Viral Infection and Bacterial Coinfection and Superinfection in Coronavirus Disease 2019 Patients Presenting to the Emergency Department Using the 29-mRNA Host Response Classifier IMX-BVN-3: A Multicenter Study", "author": "Bauer", "doi-asserted-by": "crossref", "first-page": "ofac437", "journal-title": "Open Forum Infect. Dis.", "key": "ref_38", "volume": "9", "year": "2022" }, { "DOI": "10.1371/journal.pone.0254671", "doi-asserted-by": "crossref", "key": "ref_39", "unstructured": "Cataño-Correa, J.C., Cardona-Arias, J.A., Porras Mancilla, J.P., and García, M.T. (2021). Bacterial Superinfection in Adults with COVID-19 Hospitalized in Two Clinics in Medellín-Colombia, 2020. PLoS ONE, 16." }, { "DOI": "10.1016/j.hrtlng.2021.02.015", "article-title": "The Incidence of Pleural Effusion in COVID-19 Pneumonia: State-of-the-Art Review", "author": "Chong", "doi-asserted-by": "crossref", "first-page": "481", "journal-title": "Heart Lung", "key": "ref_40", "volume": "50", "year": "2021" }, { "DOI": "10.1002/jmv.27301", "article-title": "Prevalence and Clinical Outcomes of Pleural Effusion in COVID-19 Patients: A Systematic Review and Meta-Analysis", "author": "Rathore", "doi-asserted-by": "crossref", "first-page": "229", "journal-title": "J. Med. Virol.", "key": "ref_41", "volume": "94", "year": "2022" }, { "DOI": "10.1007/s00134-023-07161-1", "article-title": "Procalcitonin and C-Reactive Protein to Rule Out Early Bacterial Coinfection in COVID-19 Critically Ill Patients", "author": "Galli", "doi-asserted-by": "crossref", "first-page": "934", "journal-title": "Intensive Care Med.", "key": "ref_42", "volume": "49", "year": "2023" }, { "article-title": "C-Reactive Protein as a Prognostic Indicator in COVID-19 Patients", "author": "Bayani", "first-page": "5557582", "journal-title": "Interdiscip. Perspect. Infect. Dis.", "key": "ref_43", "volume": "2021", "year": "2021" }, { "DOI": "10.1186/s13054-021-03717-z", "article-title": "Dexamethasone and Tocilizumab Treatment Considerably Reduces the Value of C-Reactive Protein and Procalcitonin to Detect Secondary Bacterial Infections in COVID-19 Patients", "author": "Kooistra", "doi-asserted-by": "crossref", "first-page": "281", "journal-title": "Crit. Care", "key": "ref_44", "volume": "25", "year": "2021" }, { "DOI": "10.1016/j.hrtlng.2010.11.003", "article-title": "Biomarkers for ventilator-associated pneumonia: Review of the literature", "author": "Palazzo", "doi-asserted-by": "crossref", "first-page": "293", "journal-title": "Heart Lung", "key": "ref_45", "volume": "40", "year": "2011" }, { "article-title": "New Guidelines for Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia: USA vs. Europe", "author": "Rodriguez", "first-page": "347", "journal-title": "Curr. Opin. Crit. Care", "key": "ref_46", "volume": "24", "year": "2018" }, { "DOI": "10.1186/s13054-020-03417-0", "article-title": "Risks of Ventilator-Associated Pneumonia and Invasive Pulmonary Aspergillosis in Patients with Viral Acute Respiratory Distress Syndrome Related or Not to Coronavirus 19 Disease", "author": "Razazi", "doi-asserted-by": "crossref", "first-page": "699", "journal-title": "Crit. Care", "key": "ref_47", "volume": "24", "year": "2020" }, { "DOI": "10.1007/s10096-020-04142-w", "article-title": "Nosocomial Infections Associated to COVID-19 in the Intensive Care Unit: Clinical Characteristics and Outcome", "author": "Bardi", "doi-asserted-by": "crossref", "first-page": "495", "journal-title": "Eur. J. Clin. Microbiol. Infect. Dis.", "key": "ref_48", "volume": "40", "year": "2021" }, { "DOI": "10.3390/jcm10040555", "doi-asserted-by": "crossref", "key": "ref_49", "unstructured": "Giacobbe, D.R., Battaglini, D., Enrile, E.M., Dentone, C., Vena, A., Robba, C., Ball, L., Bartoletti, M., Coloretti, I., and Di Bella, S. (2021). Incidence and Prognosis of Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19: A Multicenter Study. J. Clin. Med., 10." }, { "DOI": "10.3390/microorganisms13081791", "doi-asserted-by": "crossref", "key": "ref_50", "unstructured": "Caliman-Sturdza, O.A., Soldanescu, I., and Gheorghita, R.E. (2025). SARS-CoV-2 Pneumonia: Advances in Diagnosis and Treatment. Microorganisms, 13." }, { "DOI": "10.1016/S1473-3099(21)00626-5", "article-title": "Infection Control in the Intensive Care Unit: Expert Consensus Statements for SARS-CoV-2 Using a Delphi Method", "author": "Nasa", "doi-asserted-by": "crossref", "first-page": "e74", "journal-title": "Lancet Infect. Dis.", "key": "ref_51", "volume": "22", "year": "2022" }, { "DOI": "10.3390/antibiotics11081063", "doi-asserted-by": "crossref", "key": "ref_52", "unstructured": "Kournoutou, G.G., and Dinos, G. (2022). Azithromycin through the Lens of the COVID-19 Treatment. Antibiotics, 11." }, { "DOI": "10.1183/23120541.00046-2022", "article-title": "Ventilator-Associated Pneumonia in Critically Ill Patients with COVID-19 Infection: A Narrative Review", "author": "Boyd", "doi-asserted-by": "crossref", "first-page": "00046", "journal-title": "ERJ Open Res.", "key": "ref_53", "volume": "8", "year": "2022" }, { "DOI": "10.1001/jama.2021.11517", "article-title": "Effect of Oral Azithromycin vs. Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection: A Randomized Clinical Trial", "author": "Oldenburg", "doi-asserted-by": "crossref", "first-page": "490", "journal-title": "JAMA", "key": "ref_54", "volume": "326", "year": "2021" }, { "DOI": "10.1186/s12931-024-02779-1", "article-title": "Multidrug-Resistant Pathogens and Ventilator-Associated Pneumonia in Critically Ill COVID-19 and Non-COVID-19 Patients: A Prospective Observational Monocentric Comparative Study", "author": "Montrucchio", "doi-asserted-by": "crossref", "first-page": "168", "journal-title": "Respir. Res.", "key": "ref_55", "volume": "25", "year": "2024" }, { "DOI": "10.3390/antibiotics14090916", "doi-asserted-by": "crossref", "key": "ref_56", "unstructured": "Sakagianni, A., Koufopoulou, C., Koufopoulos, P., Feretzakis, G., and Koumaki, V. (2025). The Impact of COVID-19 on the Epidemiology of Carbapenem Resistance. Antibiotics, 14." }, { "DOI": "10.1186/s44158-022-00065-4", "article-title": "Epidemiology of Ventilator-Associated Pneumonia in ICU COVID-19 Patients: An Alarming High Rate of Multidrug-Resistant Bacteria", "author": "Tetaj", "doi-asserted-by": "crossref", "first-page": "36", "journal-title": "J. Anesth. Analg. Crit. Care", "key": "ref_57", "volume": "2", "year": "2022" }, { "DOI": "10.1186/s12866-025-04032-1", "doi-asserted-by": "crossref", "key": "ref_58", "unstructured": "Chen, F., Lin, J., Yang, W., Chen, J., Qian, X., Yan, T., Liu, X., Lu, Y., and Chen, Q. (2025). Secondary Bacterial Infections of Carbapenem-Resistant Acinetobacter baumannii in Patients with COVID-19 Admitted to Chinese ICUs. BMC Microbiol., 25." }, { "DOI": "10.1186/s13054-020-03400-9", "article-title": "Corticosteroid Use in COVID-19 Patients: A Systematic Review and Meta-Analysis on Clinical Outcomes", "author": "Vos", "doi-asserted-by": "crossref", "first-page": "696", "journal-title": "Crit. Care", "key": "ref_59", "volume": "24", "year": "2020" }, { "DOI": "10.3389/fmed.2025.1466346", "doi-asserted-by": "crossref", "key": "ref_60", "unstructured": "Bansal, V., Jain, N.K., Lal, A., Khedr, A., Tekin, A., Jama, A.B., Attallah, N., Hassan, E., Mushtaq, H.A., and Robinson, S. (2025). The Association Between Early Corticosteroid Use and the Risk of Secondary Infections in Hospitalized Patients with COVID-19: A Double-Edged Sword. Results from the International SCCM Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 Registry. Front. Med., 12." }, { "DOI": "10.3390/tropicalmed7030037", "doi-asserted-by": "crossref", "key": "ref_61", "unstructured": "Fatima, K., Almas, T., Lakhani, S., Jahangir, A., Ahmed, A., Siddiqui, A., Rahim, A., Qureshi, S.A., Arshad, Z., and Golani, S. (2022). The Use of Proton Pump Inhibitors and COVID-19: A Systematic Review and Meta-Analysis. Trop. Med. Infect. Dis., 7." }, { "DOI": "10.14309/ajg.0000000000000798", "article-title": "Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors", "author": "Almario", "doi-asserted-by": "crossref", "first-page": "1707", "journal-title": "Am. J. Gastroenterol.", "key": "ref_62", "volume": "115", "year": "2020" }, { "DOI": "10.3390/diagnostics15172244", "doi-asserted-by": "crossref", "key": "ref_63", "unstructured": "Alatawi, A.D., Hetta, H.F., Ali, M.A.S., Ramadan, Y.N., Alaqyli, A.B., Alansari, W.K., Aldhaheri, N.H., Bin Selim, T.A., Merdad, S.A., and Alharbi, M.O. (2025). Diagnostic Innovations to Combat Antibiotic Resistance in Critical Care: Tools for Targeted Therapy and Stewardship. Diagnostics, 15." }, { "DOI": "10.3390/antibiotics14010028", "doi-asserted-by": "crossref", "key": "ref_64", "unstructured": "Stoian, M., Andone, A., Bândilă, S.R., Onișor, D., Laszlo, S.Ș., Lupu, G., Danielescu, A., Baba, D.F., Văsieșiu, A.M., and Manea, A. (2025). Mechanical Ventilator-Associated Pneumonia in the COVID-19 Pandemic Era: A Critical Challenge in the Intensive Care Units. Antibiotics, 14." }, { "DOI": "10.1016/j.ajic.2024.10.014", "article-title": "Persistent carbapenem resistance in mechanically ventilated ICU patients: A before-and-after analysis of the COVID-19 surge", "author": "Antunes", "doi-asserted-by": "crossref", "first-page": "320", "journal-title": "Am. J. Infect. Control", "key": "ref_65", "volume": "53", "year": "2025" }, { "DOI": "10.1186/s12879-025-12140-6", "doi-asserted-by": "crossref", "key": "ref_66", "unstructured": "Çapar, A., Özyiğitoğlu, D., and Başlılar, Ş. (2025). Investigation of Antibiotic Resistance against Pathogens Isolated from Respiratory Samples in Intensive Care Units after SARS-CoV-2 Pandemic. BMC Infect. Dis., 25." }, { "DOI": "10.2147/IDR.S550953", "article-title": "Epidemiological and Antimicrobial Resistance Trends of Klebsiella Pneumoniae Pre-, During, and Post-COVID-19 Pandemic in a Teaching Hospital in Southwest China", "author": "Du", "doi-asserted-by": "crossref", "first-page": "5391", "journal-title": "Infect. Drug Resist.", "key": "ref_67", "volume": "18", "year": "2025" }, { "DOI": "10.1016/j.drup.2024.101124", "article-title": "An increased prevalence of carbapenem-resistant hypervirulent Klebsiella pneumoniae associated with the COVID-19 pandemic", "author": "Liu", "doi-asserted-by": "crossref", "first-page": "101124", "journal-title": "Drug Resist. Updat.", "key": "ref_68", "volume": "77", "year": "2024" }, { "DOI": "10.1016/j.ijantimicag.2023.106816", "article-title": "Diagnostic Stewardship in Infectious Diseases: A Continuum of Antimicrobial Stewardship in the Fight Against Antimicrobial Resistance", "author": "Zakhour", "doi-asserted-by": "crossref", "first-page": "106816", "journal-title": "Int. J. Antimicrob. Agents", "key": "ref_69", "volume": "62", "year": "2023" }, { "DOI": "10.1371/journal.pmed.1004314", "doi-asserted-by": "crossref", "key": "ref_70", "unstructured": "Cartuliares, M.B., Rosenvinge, F.S., Mogensen, C.B., Skovsted, T.A., Andersen, S.L., Østergaard, C., Pedersen, A.K., and Skjøt-Arkil, H. (2023). Evaluation of Point-of-Care Multiplex Polymerase Chain Reaction in Guiding Antibiotic Treatment of Patients Acutely Admitted with Suspected Community-Acquired Pneumonia in Denmark: A Multicentre Randomised Controlled Trial. PLoS Med., 20." }, { "key": "ref_71", "unstructured": "World Health Organization (2022). The WHO AWaRe (Access, Watch, Reserve) Antibiotic Book, World Health Organization." }, { "DOI": "10.1186/s13613-023-01134-9", "article-title": "Antibiotic Stewardship in the ICU: Time to Shift into Overdrive", "author": "Mokrani", "doi-asserted-by": "crossref", "first-page": "39", "journal-title": "Ann. Intensive Care", "key": "ref_72", "volume": "13", "year": "2023" }, { "DOI": "10.3389/fmed.2025.1549355", "doi-asserted-by": "crossref", "key": "ref_73", "unstructured": "Sekandarzad, A., Flügler, A., Rheinboldt, A., Rother, D., Först, G., Rieg, S., Supady, A., Lother, A., Staudacher, D.L., and Wengenmayer, T. (2025). Reduced Antimicrobial Consumption Through Enhanced Pneumonia Management in Critically Ill Patients: Outcomes of an Antibiotic Stewardship Program in the Intensive Care Unit. Front. Med., 12." }, { "DOI": "10.1093/jacamr/dlad018", "article-title": "Molecular Diagnostics for Genotypic Detection of Antibiotic Resistance: Current Landscape and Future Directions", "author": "Banerjee", "doi-asserted-by": "crossref", "first-page": "dlad018", "journal-title": "JAC Antimicrob. Resist.", "key": "ref_74", "volume": "5", "year": "2023" }, { "DOI": "10.20944/preprints202411.0180.v1", "doi-asserted-by": "crossref", "key": "ref_75", "unstructured": "Alsharksi, A.N., Sirekbasan, S., Gürkök-Tan, T., and Mustapha, A. (2024). From Tradition to Innovation: Diverse Molecular Techniques in the Fight Against Infectious Diseases. Diagnostics, 14." }, { "DOI": "10.3389/fmicb.2021.647730", "doi-asserted-by": "crossref", "key": "ref_76", "unstructured": "Abade Dos Santos, F.A., Portela, S.J., Nogueira, T., Carvalho, C.L., de Sousa, R., and Duarte, M.D. (2021). Harmless or Threatening? Interpreting the Results of Molecular Diagnosis in the Context of Virus-Host Relationships. Front. Microbiol., 12." }, { "DOI": "10.3389/fcimb.2025.1685606", "doi-asserted-by": "crossref", "key": "ref_77", "unstructured": "Li, X., Xu, H., Wang, C., Zhao, R., Wu, J., Yu, H., Wang, C., Fu, P., Deng, J., and Hua, C. (2025). COVID-19 Pandemic Increased ESKAPEEc Bloodstream Infections and Amplified Carbapenem Resistance in Chinese Children: A Multicenter Surveillance Study (2016–2023). Front. Cell. Infect. Microbiol., 15." } ], "reference-count": 77, "references-count": 77, "relation": {}, "resource": { "primary": { "URL": "https://www.mdpi.com/2079-6382/15/3/236" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "The Resistance Paradox in COVID-19 Ventilator-Associated Pneumonia: A Retrospective Study on Rapid Molecular Stewardship", "type": "journal-article", "update-policy": "https://doi.org/10.3390/mdpi_crossmark_policy", "volume": "15" }