{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T13:56:30Z","timestamp":1771941390120,"version":"3.50.1"},"reference-count":77,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"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>","DOI":"10.3390\/antibiotics15030236","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T12:19:23Z","timestamp":1771935563000},"page":"236","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Resistance Paradox in COVID-19 Ventilator-Associated Pneumonia: A Retrospective Study on Rapid Molecular Stewardship"],"prefix":"10.3390","volume":"15","author":[{"given":"Andrei Mihai","family":"B\u0103lan","sequence":"first","affiliation":[{"name":"2nd Department of Anesthesia and Intensive Care, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 8 Victor Babe\u015f Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0774-020X","authenticated-orcid":false,"given":"Tudor-Mihai","family":"Magda\u0219","sequence":"additional","affiliation":[{"name":"2nd Department of Anesthesia and Intensive Care, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 8 Victor Babe\u015f Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7685-0085","authenticated-orcid":false,"given":"Andrada Elena","family":"Urda-C\u00eempean","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 8 Victor Babe\u015f Street, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin","family":"Bodolea","sequence":"additional","affiliation":[{"name":"2nd Department of Anesthesia and Intensive Care, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 8 Victor Babe\u015f Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrada","family":"Neme\u0219","sequence":"additional","affiliation":[{"name":"2nd Department of Anesthesia and Intensive Care, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 8 Victor Babe\u015f Street, 400012 Cluj-Napoca, Romania"},{"name":"Department of Anesthesia and Intensive Care, Municipal Clinical Hospital, 400139 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2656-3234","authenticated-orcid":false,"given":"Lucre\u021bia","family":"Avram","sequence":"additional","affiliation":[{"name":"Geriatrics\u2014Gerontology, Department 5\u2014Medical Specialties, Faculty of Medicine, Iuliu Ha\u0163ieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1627-9670","authenticated-orcid":false,"given":"Dana","family":"Cri\u0219an","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 5th Medical Clinic, Clinical Municipal Hospital, Faculty of Medicine, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2455-9231","authenticated-orcid":false,"given":"Sebastian","family":"Tranc\u0103","sequence":"additional","affiliation":[{"name":"2nd Department of Anesthesia and Intensive Care, \u201cIuliu Hatieganu\u201d University of Medicine and Pharmacy, 8 Victor Babe\u015f Street, 400012 Cluj-Napoca, Romania"},{"name":"Emergency Department, The Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","unstructured":"(2022). 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