Kreitmann Louis, Vasseur Margot, Jermoumi Sonia, Perche Juliette, Richard Jean-Christophe, Wallet Florent, Chabani Myriam, Nourry Emilie, Garçon Pierre, Zerbib Yoann, Van Grunderbeeck Nicolas, Vinsonneau Christophe, Preda Cristian, Labreuche Julien, Nseir Saad
Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France.
Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France.
Intensive Care Med. 2023 Feb;49(2):154-165. doi: 10.1007/s00134-022-06954-0. Epub 2023 Jan 2.
The impact of immunosuppression on intensive care unit (ICU)-acquired colonization and infection related to multidrug-resistant (MDR) bacteria (ICU-MDR-col and ICU-MDR-inf, respectively) is unknown.
We carried out an observational prospective cohort study in 8 ICUs in France (all with single-bed rooms and similar organizational characteristics). All consecutive patients with an ICU stay > 48 h were included, regardless of immune status, and followed for 28 days. Patients underwent systematic screening for colonization with MDR bacteria upon admission and every week subsequently. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, solid-organ transplant, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic. The primary endpoint was the incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.
750 patients (65.9% males, median age 65 years) were included, among whom 264 (35.2%) were immunocompromised. Reasons for ICU admission, severity scores and exposure to invasive devices and antibiotics during ICU stay were comparable between groups. After adjustment for center and pre-specified baseline confounders, immunocompromised patients had a lower incidence rate of ICU-MDR-col and/or ICU-MDR-inf (adjusted incidence ratio 0.68, 95% CI 0.52-0.91). When considered separately, the difference was significant for ICU-MDR-col, but not for ICU-MDR-inf. The distribution of MDR bacteria was comparable between groups, with a majority of Enterobacteriacae resistant to third-generation cephalosporins (~ 74%).
Immunocompromised patients had a significantly lower incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. This finding points to the role of contact precautions and isolation measures, and could have important implications on antibiotic stewardship in this population.
免疫抑制对重症监护病房（ICU）获得性定植及与多重耐药（MDR）菌相关感染（分别为ICU-MDR-定植和ICU-MDR-感染）的影响尚不清楚。
我们在法国的8个ICU开展了一项观察性前瞻性队列研究（所有ICU均为单人病房且组织特征相似）。纳入所有在ICU住院时间超过48小时的连续患者，无论其免疫状态如何，并随访28天。患者入院时及随后每周均接受MDR菌定植的系统筛查。免疫抑制定义为患有活动性癌症或血液系统恶性肿瘤、中性粒细胞减少、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及遗传性疾病。主要终点是包括ICU-MDR-定植和/或ICU-MDR-感染在内的复合结局的发生率。
共纳入750例患者（男性占65.9%，中位年龄65岁），其中264例（35.2%）为免疫功能低下患者。两组间ICU入院原因、严重程度评分以及ICU住院期间侵入性设备和抗生素的使用情况具有可比性。在对中心和预先指定的基线混杂因素进行调整后，免疫功能低下患者发生ICU-MDR-定植和/或ICU-MDR-感染的发生率较低（调整后的发生率比值为0.68，95%置信区间为0.52-0.91）。单独考虑时，ICU-MDR-定植差异有统计学意义，而ICU-MDR-感染差异无统计学意义。两组间MDR菌的分布具有可比性，大多数肠杆菌科细菌对第三代头孢菌素耐药（约74%）。
免疫功能低下患者发生包括ICU-MDR-定植和/或ICU-MDR-感染在内的复合结局的发生率显著较低。这一发现表明了接触预防措施和隔离措施的作用，并且可能对该人群的抗生素管理具有重要意义。
