ICU-acquired pneumonia in immunosuppressed patients with acute hypoxemic respiratory failure: A post-hoc analysis of a prospective international cohort study
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 & ndash;3.39) and invasive me-chanical ventilation at day 1 (OR 2.12 vs. high flow oxygen; 95%CI 1.07 & ndash;4.20) were associated with increased risk of ICU-AP while female gender (OR 0.63; 95%CI 0.43 & ndash;94) and chronic kidney disease (OR 0.43; 95%CI 0.22 & ndash;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.& ndash;1.91; P = 0.003). Conclusions: The attributable mortality of ICU-AP has been repetitively questioned in immunosuppressed pa-tients with acute respiratory failure.
This manuscript found that ICU-AP represents an independent risk factor for hospital mortality. (c) 2020 Elsevier Inc. All rights reserved.