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Abstract：
BACKGROUND: Immunosuppression at intensive care unit (ICU) admission has been associated with a higher incidence of ICU-acquired infections, some of them related to opportunistic pathogens. However, the association of immunosuppression with the incidence, microbiology and outcomes of ICU-acquired bacterial bloodstream infections (BSI) has not been thoroughly investigated.
METHODS: Retrospective single-centered cohort study in France. All adult patients hospitalized in the ICU of Lille University-affiliated hospital for > 48 h between January 1st and December 31st, 2020, were included, regardless of their immune status. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, hematopoietic stem cell and solid organ transplants, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic immune deficiency. The primary objective was to compare the 28-day cumulative incidence of ICU-acquired bacterial BSI between immunocompromised and non-immunocompromised patients. Secondary objectives were to assess the microbiology and outcomes of ICU-acquired bacterial BSI in the two groups.
RESULTS: A total of 1313 patients (66.9% males, median age 62 years) were included. Among them, 271 (20.6%) were immunocompromised at ICU admission. Severity scores at admission, the use of invasive devices and antibiotic exposure during ICU stay were comparable between groups. Both prior to and after adjustment for pre-specified baseline confounders, the 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between immunocompromised and non-immunocompromised patients. The distribution of bacteria was comparable between groups, with a majority of Gram-negative bacilli (~ 64.1%). The proportion of multidrug-resistant bacteria was also similar between groups. Occurrence of ICU-acquired bacterial BSI was associated with a longer ICU length-of-stay and a longer duration of invasive mechanical ventilation, with no significant association with mortality. Immune status did not modify the association between occurrence of ICU-acquired bacterial BSI and these outcomes.
CONCLUSIONS: The 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between patients with and without immunosuppression at ICU admission.
METHODS: Retrospective single-centered cohort study in France. All adult patients hospitalized in the ICU of Lille University-affiliated hospital for > 48 h between January 1st and December 31st, 2020, were included, regardless of their immune status. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, hematopoietic stem cell and solid organ transplants, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic immune deficiency. The primary objective was to compare the 28-day cumulative incidence of ICU-acquired bacterial BSI between immunocompromised and non-immunocompromised patients. Secondary objectives were to assess the microbiology and outcomes of ICU-acquired bacterial BSI in the two groups.
RESULTS: A total of 1313 patients (66.9% males, median age 62 years) were included. Among them, 271 (20.6%) were immunocompromised at ICU admission. Severity scores at admission, the use of invasive devices and antibiotic exposure during ICU stay were comparable between groups. Both prior to and after adjustment for pre-specified baseline confounders, the 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between immunocompromised and non-immunocompromised patients. The distribution of bacteria was comparable between groups, with a majority of Gram-negative bacilli (~ 64.1%). The proportion of multidrug-resistant bacteria was also similar between groups. Occurrence of ICU-acquired bacterial BSI was associated with a longer ICU length-of-stay and a longer duration of invasive mechanical ventilation, with no significant association with mortality. Immune status did not modify the association between occurrence of ICU-acquired bacterial BSI and these outcomes.
CONCLUSIONS: The 28-day cumulative incidence of ICU-acquired bacterial BSI was not statistically different between patients with and without immunosuppression at ICU admission.
摘要：
背景：重症监护病房（ICU）入院时的免疫抑制与ICU获得性感染的发生率较高有关，其中一些与机会病原体有关。然而,免疫抑制与发病率的关系，ICU获得性细菌性血流感染（BSI）的微生物学和结局尚未得到彻底研究。
方法：法国的回顾性单中心队列研究。1月1日至12月31日，所有在里尔大学附属医院ICU住院时间>48h的成年患者，包括2020年，不管他们的免疫状况如何。免疫抑制被定义为活动性癌症或恶性血液病，中性粒细胞减少症,造血干细胞和实体器官移植，使用类固醇或免疫抑制药物，人类免疫缺陷病毒感染和遗传性免疫缺陷。主要目的是比较免疫受损和非免疫受损患者ICU获得性细菌BSI的28天累积发生率。次要目标是评估两组ICU获得性细菌BSI的微生物学和结果。
结果：共有1313例患者（66.9%为男性，中位年龄62岁)。其中,入住ICU时，271例（20.6%）免疫受损。入院时的严重分数，两组间的侵入性器械使用情况和ICU住院期间的抗生素暴露情况具有可比性.在调整预先指定的基线混杂因素之前和之后，免疫功能低下和非免疫功能低下患者的ICU获得性细菌性BSI的28天累积发生率无统计学差异.各组间细菌分布相当,与大多数革兰氏阴性杆菌（~64.1%）。组间多重耐药细菌的比例也相似。ICU获得性细菌性BSI的发生与较长的ICU住院时间和较长的有创机械通气持续时间相关。与死亡率没有显著关联。免疫状态并未改变ICU获得性细菌BSI的发生与这些结果之间的关联。
结论：ICU入院时，有和没有免疫抑制的患者ICU获得性细菌性BSI的28天累积发生率没有统计学差异。
方法：法国的回顾性单中心队列研究。1月1日至12月31日，所有在里尔大学附属医院ICU住院时间>48h的成年患者，包括2020年，不管他们的免疫状况如何。免疫抑制被定义为活动性癌症或恶性血液病，中性粒细胞减少症,造血干细胞和实体器官移植，使用类固醇或免疫抑制药物，人类免疫缺陷病毒感染和遗传性免疫缺陷。主要目的是比较免疫受损和非免疫受损患者ICU获得性细菌BSI的28天累积发生率。次要目标是评估两组ICU获得性细菌BSI的微生物学和结果。
结果：共有1313例患者（66.9%为男性，中位年龄62岁)。其中,入住ICU时，271例（20.6%）免疫受损。入院时的严重分数，两组间的侵入性器械使用情况和ICU住院期间的抗生素暴露情况具有可比性.在调整预先指定的基线混杂因素之前和之后，免疫功能低下和非免疫功能低下患者的ICU获得性细菌性BSI的28天累积发生率无统计学差异.各组间细菌分布相当,与大多数革兰氏阴性杆菌（~64.1%）。组间多重耐药细菌的比例也相似。ICU获得性细菌性BSI的发生与较长的ICU住院时间和较长的有创机械通气持续时间相关。与死亡率没有显著关联。免疫状态并未改变ICU获得性细菌BSI的发生与这些结果之间的关联。
结论：ICU入院时，有和没有免疫抑制的患者ICU获得性细菌性BSI的28天累积发生率没有统计学差异。
