TY - JOUR
T1 - Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections
AU - Moreau, Anne-Sophie
AU - Martin-Loeches, Ignacio
AU - Povoa, Pedro
AU - Salluh, Jorge
AU - Rodriguez, Alejandro
AU - Thille, Arnaud W
AU - Diaz Santos, Emilio
AU - Vedes, Elisa
AU - Margareth Lobo, Suzana
AU - Mégarbane, Bruno
AU - Molero Silvero, Esperanza
AU - Coelho, Luis
AU - Argaud, Laurent
AU - Sanchez Iniesta, Rafael
AU - Labreuche, Julien
AU - Rouzé, Anahita
AU - Nseir, Saad
AU - TAVeM study Group
N1 - Copyright ©ERS 2018.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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.
KW - Journal Article
U2 - 10.1183/13993003.01656-2017
DO - 10.1183/13993003.01656-2017
M3 - Article
C2 - 29439020
SN - 0903-1936
JO - European Respiratory Journal
JF - European Respiratory Journal
M1 - 1701656
ER -