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Eur Respir J. 2018 Mar 8;51(3). pii: 1701656. doi: 10.1183/13993003.01656-2017. Print 2018 Mar.

Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections.

Collaborators (140)

Martín-Loeches I, Rodriguez A, Curcio D, Fernández RO, Arroyo J, Gabriela M, Alvarez R, Reyes AT, Dellera C, Molina F, Franco DM, Chapeta Parada EG, Yepez ES, Oña FP, Tutillo DM, Barahona DM, Lerma FA, Álvarez AA, Gallego JMA, Morillas FJF, Aguilar ALR, Lorenzana MLC, Iniesta RS, Almirall J, Albaya ALR, Santana SR, Fernandez C, Potro MABN, Cortes PV, Jimenez B, Sierra R, Del Valle Ortiz M, Cruza N, Olaechea PM, Zirena ACC, Gonzalez PP, Gomez TR, Crespi LS, Galleymore PR, Marcos RJ, Palazón C, Rueda BG, Ballesteros JC, Arnilla MPG, Socias A, Amador J, Silvero EM, Redín LM, Elson MZ, Pericas LC, Rodríguez JÁ, Nieto M, Torres A, Molinos E, Josefina A, Catorze N, Póvoa P, Candeias C, Coelho LC, André P, Gomes JA, Vedes E, Fernandes A, Ángel García M, Ramirez CS, Calizaya M, Estella A, Albis A, Aguilar G, Torrents E, Puente MG, Sanchez AG, Lisboa T, Azambuja P, Knibel MF, Ranzani O, Camargo LDW, Junior APN, Ferreira CB, Lobo S, Rabello L, Park M, de Carvalho AGR, Valencia M, Castro AG, López AA, Caballero JMC, Nseir S, Jaffal K, Parmentier-Decrucq E, Préau S, Rousselin C, Blazejewski C, Masse J, Robriquet L, Satre-Buisson L, Mira JP, Martin N, Lepecq R, Mentec H, Girault C, Marchalot A, Messika J, Ricard JD, Seguin P, Mégarbane B, Valade S, Azoulay E, Boussekey N, Leroy O, Reignier J, Clavel M, Pichon N, Baudry T, Argaud L, Beuret P, Hssain AA, Nyunga M, Alves I, Dewavrin F, Brunin G, Mérat S, Pasquier P, Brun F, Palud A, Voisin B, Grenot R, Van Grunderbeeck N, Thévenin D, Misset B, Philippart F, Frat JP, Coudroy R, Cabaret P, Ledein M, Hadj Slimane FZ, Miguel-Montanes R, Weiss N, Bolgert F, Just B.

Author information

1
Centre de Réanimation, CHU Lille, Lille, France.
2
Dept of Clinical Medicine, Trinity College, Welcome Trust-HRB Clinical Research Facility, St James Hospital, Dublin, Ireland.
3
Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
4
NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisbon, Portugal.
5
Dept of Critical Care, D'Or Institute for Research and Education, Rio De Janeiro, Brazil.
6
Critical Care Dept, Joan XXIII University Hospital, Tarragona, Spain.
7
CHU de Poitiers, Réanimation Médicale, Faculté de Médecine et de Pharmacie de Poitiers, Université de Poitiers, INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France.
8
Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, CIBER de Enfermedades Respiratorias (CIBERES), Sabadell, Spain.
9
Unidade de Cuidados Intensivos do Hospital da Luz, Lisbon, Portugal.
10
Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil.
11
Dept of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS-1144, Paris, France.
12
Intensive Medicine Unit, Gómez Ulla Hospital, Madrid, Spain.
13
Service de Réanimation Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
14
General de Albacete, Albacete, Spain.
15
CHU Lille, Clinique de Santé Publique, Plateforme d'Aide Méthodologique, Lille, France.
16
Medical School, Lille University, Lille, France.

Abstract

The aim of this planned analysis of the prospective multinational TAVeM database was to determine the incidence, aetiology and impact on outcome of ventilator-associated lower respiratory tract infections (VA-LRTI) in immunocompromised patients.All patients receiving mechanical ventilation for >48 h were included. Immunocompromised patients (n=663) were compared with non-immunocompromised patients (n=2297).The incidence of VA-LRTI was significantly lower among immunocompromised than among non-immunocompromised patients (16.6% versus 24.2%; sub-hazard ratio 0.65, 95% CI 0.53-0.80; p<0.0001). Similar results were found regarding ventilator-associated tracheobronchitis (7.3% versus 11.6%; sub-hazard ratio 0.61, 95% CI 0.45-0.84; p=0.002) and ventilator-associated pneumonia (9.3% versus 12.7%; sub-hazard ratio 0.72, 95% CI 0.54-0.95; p=0.019). Among patients with VA-LRTI, the rates of multidrug-resistant bacteria (72% versus 59%; p=0.011) and intensive care unit mortality were significantly higher among immunocompromised than among non-immunocompromised patients (54% versus 30%; OR 2.68, 95% CI 1.78-4.02; p<0.0001). In patients with ventilator-associated pneumonia, mortality rates were higher among immunocompromised than among non-immunocompromised patients (64% versus 34%; p<0.001).Incidence of VA-LRTI was significantly lower among immunocompromised patients, but it was associated with a significantly higher mortality rate. Multidrug-resistant pathogens were more frequently found in immunocompromised patients with VA-LRTI.

Conflict of interest statement

Conflict of interest: S. Nseir has received personal fees (for advisory board work) from Bayer and Ciel Medical, and personal fees (for lectures) from MSD and Medtronic, outside the submitted work.

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