背景:治疗性血浆置换(TPE),影响体液反应,通常与免疫抑制药物联合使用。出于这个原因,TPE可能与感染易感性增加有关。我们旨在描述接受TPE治疗的ICU患者的血流感染(BSI)发生率,并确定相关的危险因素。
方法:我们回顾性地纳入了在4个参与中心之一的ICU中至少接受过一次TPE的患者(均在巴黎,法国)在2010年1月1日至2019年12月31日之间。将在ICU住院期间出现BSI的患者与没有这种感染的患者进行比较。通过多变量逻辑回归模型确定BSI的危险因素。
结果:在4个ICU中超过10年,包括387名患者,每位患者的中位数为5[2-7]次TPE。TPE最常见的适应症是血栓性微血管病(47%),中枢神经系统炎症性疾病(11%),高粘度综合征(11%)和ANCA相关性血管炎(8.5%)。31名患者(8%)在ICU住院期间出现BSI,TPE开始后的中位数为7[3-11]天。在多元逻辑回归模型中,糖尿病(OR3.32[1.21-8.32])和TPE总次数(OR1.14[1.08-1.20])是BSI的独立危险因素.TPE导管感染相关的BSI(n=11(35%))和其他来源的BSI(n=20(65%))在导管插入部位(p=0.458)或TPE导管相关的深静脉血栓形成率(p=0.601)方面没有差异。与没有BSI的患者相比,出现BSI的患者ICU病程严重,对机械通气的需求较高(45%对18%,p=0.001),肾脏替代疗法(42%对20%,p=0.011),血管升压药(32%vs12%,p=0.004)和更高的死亡率(19%对5%,p=0.010)。
结论:在ICU接受TPE的患者中,血流感染频繁,并与严重的ICU病程有关。警惕监测是至关重要的,特别是对于接受大量TPE课程的患者。
BACKGROUND: Therapeutic plasma exchanges (TPE), which affect the humoral response, are often performed in combination with immunosuppressive drugs. For this reason, TPE may be associated with an increased susceptibility to infections. We aimed to describe blood stream infection (BSI) incidence in ICU patients treated with TPE and to identify associated risk factors.
METHODS: We retrospectively included patients that had received at least one session of TPE in the ICU of one of the 4 participating centers (all in Paris, France) between January 1st 2010 and December 31th 2019. Patients presenting with a BSI during ICU stay were compared to patients without such an infection. Risk factors for BSI were identified by a multivariate logistic regression model.
RESULTS: Over 10 years in the 4 ICUs, 387 patients were included, with a median of 5 [2-7] TPE sessions per patient. Most frequent indications for TPE were thrombotic microangiopathy (47%), central nervous system inflammatory disorders (11%), hyperviscosity syndrome (11%) and ANCA associated vasculitis (8.5%). Thirty-one patients (8%) presented with a BSI during their ICU stay, a median of 7 [3-11] days after start of TPE. In a multivariate logistic regression model, diabetes (OR 3.32 [1.21-8.32]) and total number of TPE sessions (OR 1.14 [1.08-1.20]) were independent risk factors for BSI. There was no difference between TPE catheter infection related BSI (n = 11 (35%)) and other sources of BSI (n = 20 (65%)) regarding catheter insertion site (p = 0.458) or rate of TPE catheter related deep vein thrombosis (p = 0.601). ICU course was severe in patients presenting with BSI when compared to patients without BSI, with higher need for mechanical ventilation (45% vs 18%, p = 0.001), renal replacement therapy (42% vs 20%, p = 0.011), vasopressors (32% vs 12%, p = 0.004) and a higher mortality (19% vs 5%, p = 0.010).
CONCLUSIONS: Blood stream infections are frequent in patients receiving TPE in the ICU, and are associated with a severe ICU course. Vigilant monitoring is crucial particularly for patients receiving a high number of TPE sessions.