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

Anne-Sophie Moreau, Ignacio Martin-Loeches, Pedro Povoa, Jorge Salluh, Alejandro Rodriguez, Arnaud W Thille, Emilio Diaz Santos, Elisa Vedes, Suzana Margareth Lobo, Bruno Mégarbane, Esperanza Molero Silvero, Luis Coelho, Laurent Argaud, Rafael Sanchez Iniesta, Julien Labreuche, Anahita Rouzé, Saad Nseir, TAVeM study Group

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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 in immunocompromised than in non-immunocompromised patients (16.6%versus24.2%, p<0.0001, Subhazard ratio 0.65 (0.53-0.80)). Similar results were found regarding ventilator-associated tracheobronchitis (VAT) (7.3%versus11.6%, p=0.002, 0.61 (0.45-0.84)), and ventilator-associated pneumonia (VAP) (9.3%versus12.7%, p=0.019, 0.72 (0.54-0.95)). Among patients with VA-LRTI, the rates of multidrug resistant (MDR) bacteria (72%versus59%, p=0.011), and ICU mortality were significantly higher in immunocompromised compared with non-immunocompromised patients (54%,versus30%, p<0.0001, OR 2.68 (95% CI 1.78-4.02)). In patients with VAP, mortality rates were higher in immunocompromised than in non-immunocompromised patients (64%versus34%, p<0.001).Incidence of VA-LRTI was significantly lower in immunocompromised compared with non-immunocompromised patients, but it was associated with significantly higher mortality rate. MDR pathogens were more frequently found in immunocompromised patients with VA-LRTI.

Original languageEnglish
Article number1701656
JournalEuropean Respiratory Journal
Early online date8 Feb 2018
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Journal Article

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