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

Abstract：

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.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Martin-Loeches I,Darmon M,Demoule A,Antonelli M,Schellongowski P,Pickkers P,Soares M,Rello J,Bauer P,van de Louw A,Lemiale V,Grimaldi D,Balik M,Mehta S,Kouatchet A,Barratt-Due A,Valkonen M,Reignier J,Metaxa V,Moreau

doi

10.1016/j.jcrc.2020.09.027

subject

Has Abstract

pub_date

2020-09-29 00:00:00

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(20)30706-1

pub_type

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