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Article Dans Une Revue European Respiratory Journal Année : 2018

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

Résumé

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 \textgreater48 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\textless0.0001). Similar results were found regarding ventilator-associated tracheobronchitis (7.3% versus 11.6%; subhazard 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 multidrugresistant 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\textless0.0001). In patients with ventilator-associated pneumonia, mortality rates were higher among immunocompromised than among non-immunocompromised patients (64% versus 34%; p\textless0.001). 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.

Dates et versions

hal-01847389 , version 1 (23-07-2018)

Identifiants

Citer

Anne-Sophie Moreau, Ignacio Martin-Loeches, Pedro Povoa, Jorge Salluh, Alejandro Rodriguez, et al.. Impact of immunosuppression on incidence, aetiology and outcome of ventilator-associated lower respiratory tract infections. European Respiratory Journal, 2018, 51 (3), pp.1701656. ⟨10.1183/13993003.01656-2017⟩. ⟨hal-01847389⟩
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