ICU-acquired pneumonia in immunosuppressed patients with acute hypoxemic respiratory failure: A post-hoc analysis of a prospective international cohort study.

Autor: Martin-Loeches I; Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO) and Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland; Hospital de Barcelona, IDIBAPS, CIBERes, Barcelona, Spain. Electronic address: imartinl@tcd.ie., Darmon M; Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology, France., Demoule A; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France., Antonelli M; Department of Anesthesia, Intensive Care and Emergency Medicine, Fondazione Ospedale Universitario A. Gemelli IRCCS, Italy; Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Rome, Italy., Schellongowski P; Department of Medicine I, Medical University of Vienna, Vienna, Austria., Pickkers P; Department of Intensive Care Medicine (710), Radboud University Medical Center, Nijmegen, The Netherlands., Soares M; Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduação em Clínica Médica, Rio De Janeiro, Brazil., Rello J; CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain., Bauer P; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA., van de Louw A; Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA., Lemiale V; Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology, France., Grimaldi D; Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium., Balik M; Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic., Mehta S; Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada., Kouatchet A; Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France., Barratt-Due A; Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway., Valkonen M; Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Reignier J; Medical Intensive Care Unit, Hôtel Dieu-HME University Hospital of Nantes, Nantes, France., Metaxa V; Department of Critical Care, King's College Hospital, NHS Foundation Trust, London SE5 9RS, UK., Moreau AS; Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France., Burghi G; Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay., Mokart D; Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France., Azoulay E; Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology, France.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2021 Jun; Vol. 63, pp. 243-245. Date of Electronic Publication: 2020 Sep 29.
DOI: 10.1016/j.jcrc.2020.09.027
Abstrakt: Objective: Intensive Care Units (ICU) acquired Pneumonia (ICU-AP) is one of the most frequent nosocomial infections in critically ill patients. Our aim was to determine the effects of having an ICU-AP in immunosuppressed patients with acute hypoxemic respiratory failure.
Design: Post-hoc analysis of a multinational, prospective cohort study in 16 countries.
Settings: ICU.
Patients: Immunosuppressed patients with acute hypoxemic respiratory failure.
Intervention: None.
Measurements and Main Results: The original cohort had 1611 and in this post-hoc analysis a total of 1512 patients with available data on hospital mortality and occurrence of ICU-AP were included. ICU-AP occurred in 158 patients (10.4%). Hospital mortality was higher in patients with ICU-AP (14.8% vs. 7.1% p < 0.001). After adjustment for confounders and centre effect, use of vasopressors (Odds Ratio (OR) 2.22; 95%CI 1.46-3.39) and invasive mechanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07-4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43-94) and chronic kidney disease (OR 0.43; 95%CI 0.22-0.88) were associated with decreased risk of ICU-AP. After adjustment for confounders and centre effect, ICU-AP was independently associated with mortality (Hazard Ratio 1.48; 95%CI 14.-1.91; P = 0.003).
Conclusions: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed patients with acute respiratory failure. This manuscript found that ICU-AP represents an independent risk factor for hospital mortality.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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